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October 23, 2014

Improper Federal Payments Are Back, This Time in Texas

To the litany of reasons why the federal government makes improper payments, add this: providers of non-emergency medical transportation (NEMT) for Medicaid patients submitted claims to Medicaid...

October 23, 2014

FDA, Industry Reps Say Providers, Device Makers Should Share Data on Cyber Risks

Health-care organizations and medical device manufacturers should share more information with each other about medical device cybersecurity vulnerabilities, federal health and technology...

October 22, 2014

Is Congress Ready to Take Action on Health Information Exchange?

I trekked out to Reston yesterday to take in WEDI's fall conference, and speakers were eager to talk about the benefits of health information exchange and what the future holds. Mary Grealy, the...

October 22, 2014

CMS Outlines Methodology to Determine Payments Under Basic Health Program

The CMS has released methodology and data sources for determining federal payments in 2016 to states establishing an alternative coverage program for low-income people under the Affordable Care...

October 21, 2014

Hospital Associations Supporting CMS Price Transparency Requirement

A new CMS requirement for hospitals to publicize a list of their standard charges for items and services enjoys support from the Federation of American Hospitals and the American Hospital...

October 17, 2014

Can Tax Revenue Really Be Used to Pay for Out-Of-Pocket Expenses?

At first glance, the idea that a township could use tax revenue to cover out-of-pocket expenses for patients using emergency ambulance services sounds like a clear violation of the anti-kickback...

October 16, 2014

Second ACA Enrollment Effort Entering `Last Stretch’

With the second open enrollment period for the Affordable Care Act marketplaces set to start Nov. 15, the government’s chief executive officer in charge of the operation gave the health...

October 16, 2014

Looking for the ACO Waiver Final Rule? Wait Until Next Year

If you're eagerly awaiting the publication of the CMS and OIG final rule on fraud and abuse waivers for ACOs, I've got some bad news for you: it's going to be another year. CMS and OIG recently ...

October 16, 2014

How Will Medicaid Plans Cover Specialty Drugs?

As a new hepatitis c drug is approved with a high price tag, state Medicaid plans are trying to figure out how to minimize the impact of the cost.

October 15, 2014

CMS Attempting to Jump-Start ACO Program

The CMS is attempting to jump-start growth in the Accountable Care Organizations program by providing $114 million in funding for infrastructure investments and care management improvements. ...

October 10, 2014

Burwell Tries to Control Expectations Before Second ACA Open Enrollment

In a wide ranging question-and-answer session with the media, Department of Health and Human Services Secretary Sylvia Mathews Burwell Oct. 9 tried to control expectations about the upcoming...

October 9, 2014

2015 Part B Premium, Deductible Unchanged, CMS Says

The HHS says 2015 Medicare Part B premiums and deductibles will remain the same as they have for the last two years, due in part to lower program growth since passage of the Affordable Care...

October 9, 2014

Speaker Paints Stark Picture of Un-Revised Patent Eligibility Guidance

The Patent and Trademark Office has promised revisions in its guidance on the patent eligibility of naturally-occurring products, and one conference speaker employed a unique way to...

October 9, 2014

Why are Copays So High for Critical-Access Hospitals?

While everyone's familiar with what a copayment is, they might not know that there's a big difference in copayments between critical-access hospitals (CAHs) and acute-care hospitals. A recent OIG ...

October 8, 2014

Notes from AHLA's Fraud and Compliance Forum

I recently spent two days in Baltimore, home to the AL East champion Orioles and the site of the AHLA's 2014 Fraud and Compliance forum, and thought I'd pass on a few takeaways. The forum kicked off...

October 8, 2014

Industry Groups Asking Congress to Outline FDA Oversight of Health IT

Nearly 60 health information technology groups and various industry associations are circulating a letter among member of Congress asking for legislation that clarifies the Food and Drug...

October 6, 2014

WellPoint, Gilead Debate Drug Costs

Since the “$1,000 a pill” wonder drug Sovaldi has been making headlines for its success at curing hepatitis C, health insurers have ramped up a campaign to rein in soaring costs for specialty...

October 3, 2014

Finding a Safe Harbor in Anti-Kickback Seas

Safe harbors always sound like a good thing, especially when they offer protection against the anti-kickback statute, and a recent expansion proposed by the OIG is sure to please providers. The...

October 1, 2014

CMS Needs Better Oversight of State Medicaid Managed Care Plans

CMS isn't doing enough to enforce requirements that states provide adequate access to doctors, OIG says in a recent report.

October 1, 2014

Let the Sunshine in, Open Payments is Finally Here

After months of anticipation (and not a little angst from physicians and drug and device manufacturers), CMS has publicly released the Open Payments database, and as we head into this new phase in...

October 1, 2014

Device Makers Should Think About Cybersecurity, FDA Says

Device manufacturers should consider cybersecurity risks as part of the design and development of their products, the Food and Drug Administration said in releasing a final guidance Oct. 1. ...

October 1, 2014

GAO: Integrating Benefits for Duals May Not Produce Medicare Savings

The GAO is questioning the push by the CMS and Congress to better integrate care for the disabled who are eligible for Medicare and Medicaid, saying that while it may improve quality outcomes,...

September 30, 2014

As Meaningful Use Reporting Deadline Approaches, CMS Announces Hardship Exception Figures

Roughly 44,000 providers applied for hardship exceptions from the meaningful use program this year in hopes of avoiding a Medicare penalty next year, the Centers for Medicare & Medicaid...

September 26, 2014

Just How Viable an Option is the Private Option?

In spite of recent GAO findings, analysts say the private plan option for expanding Medicaid can work in other states.

September 26, 2014

Public Citizen Wants Medicare to Change Physician Pay Rate-Setting Procedure

AMA, RUC, health care reform, Obamacare, ACA, physicians, Medicare, Public Citizen, SGR

September 26, 2014

McKinsey: ACA Marketplace Competition Increasing But Premiums Could Rise for Subsidy-Eligible

Health care analysts have been warning that if people who receive subsidies for their Affordable Care Act marketplace health plans rely on automatic renewals during open enrollment for...

September 25, 2014

Revisiting ICD-10, Again

I recently attended a congressional staff briefing sponsored by the Coalition for ICD-10, and the takeaway from the panelists was as clear as it gets: don't delay ICD-10 again. A mixture of...

September 24, 2014

Analysis Finds Number of 2015 Plans Lowest Since Start of Part D Drug Benefit

Obamacare, Medicare, Medicare prescription drugs, CMS, prescription drugs, seniors

September 24, 2014

Federal Security Officials Say Cyberattacks on Health Companies Expected to Increase

Federal officials are warning health-care companies to expect more cyber attacks in the coming year. Over the past two years, hacking and other malicious cyberattacks accounted for only about...

September 23, 2014

Judge Says Cases Define What It Means to Be Human

A federal district court judge told a conference Sept. 12 that recent cases on gene patents and bioethics issues will be long remembered because they are defining what it means to be human. ...

September 23, 2014

Solving the Mystery of What Scalia Said

A federal district court judge attempted to solve a mystery in what is known as the Myriad gene patent case: why did Supreme Court Justice Antonin Scalia concur with everything about the opinion...

September 22, 2014

Is Context Key for Open Payments Program?

Context is often the key to understanding jokes, anecdotes and any other fun bits of information, and if three industry associations are to be believed, it's also key to understanding data in CMS's...

September 22, 2014

Researchers: Electronic Health Records Can Help Make Patients Safer

Adoption of an electronic health record system with advanced physician alerts and order entry assistance can significantly improve patient safety in a hospital or physician group practice,...

September 19, 2014

ACA Rate Review Provision Saved Consumers $1B in 2013, HHS Says

The Department of Health and Human Services is touting savings realized by consumers as a result of an Affordable Care Act provision requiring health insurers to justify premium increases. ...

September 19, 2014

Using Copayment Coupons for Part D Drugs? OIG Says Think Again.

A copayment coupon sounds like a great idea, giving patients the ability to pay little or no copay for their prescription drugs. Mix a copayment coupon with a drug paid for by Medicare Part D...

September 18, 2014

Unnecessary Chemo is the Worst Kind of Health-Care Fraud

Health-care fraud, in all it's various and sundry forms, is wrong, but never more so than when patient care is affected. A recent guilty plea from a Detroit-area oncologist is a case in point. Farid...

September 16, 2014

ACOs Improve Quality, Save Money, CMS Says

Accountable care organizations created under the Affordable Care Act are meeting their goals of improving patient care while saving Medicare money, the Centers for Medicare & Medicaid...

September 12, 2014

Telemedicine Debate Continues Amid New Guidance, Reports

The debate over how to improve access to telemedicine services continued this month in the wake of new model legislation from the Federation of State Medical Boards aimed at helping states...

September 12, 2014

Hackbarth To Leave MedPAC After 15 Years

Medicare Payment Advisory Commission Chairman Glenn Hackbarth, who was first appointed to the commission in 2000, will leave the panel in April 2015. He has been chairman since 2001. A resident...

September 12, 2014

WellPoint, Blue Cross and Blue Shield Plans Leading Market Share in 2014 ACA Marketplaces

Avalere Health LLC confirmed anecdotal evidence that health insurer WellPoint Inc. and various independent Blue Cross and Blue Shield plans captured the greatest percentage of customers in the...

September 12, 2014

Are Rural Health Clinics Getting More Than They Deserve from Medicare?

Rural health clinics (RHCs) are designed to serve some of the most remote parts of the country, and as such, they receive extra Medicare and Medicaid reimbursements for their services. However, a...

September 12, 2014

Did HHS Break Its Own Medicaid Waiver Rules?

A recent GAO report finds Arkansas's plan to use premium support to expand Medicaid isn't budget neutral, and faults the HHS process to approve such plans.

September 9, 2014

Louisiana Overpaid Hospitals $3M in Medicaid Meaningful Use Payments

Louisiana's Medicaid agency overpaid more than a dozen hospitals a total of $3.1 million in Medicaid meaningful use incentive payments in 2011, according to a Sept. 8 report by the Department...

September 9, 2014

Burwell Calls for Cooperation, End to Partisan Attacks on ACA

In her first major public remarks since being confirmed in June, HHS Secretary Sylvia Mathews Burwell Sept. 8 defended the Affordable Care Act and called for an end to partisan strife over...

September 8, 2014

Kaiser Study Finds Costs Dropping For Benchmark ACA Health Plans

A perpetual question about the Affordable Care Act is whether health insurance plans offered through its marketplaces will actually be affordable, or whether the law will result in premium...

September 8, 2014

Industry to CMS: Keep the CME Sunshine Reporting Exemption

It's official. The vast bulk of health-care industry stakeholders want CMS to keep the continuing medical education (CME) reporting exemption under the Open Payments program. According to the CME...

September 5, 2014

House Set to Vote on Group Insurance Plans

House Republicans promise to pass a bill allowing employees to keep non-ACA compliant group health plans.

September 5, 2014

CMS, Treasury to Team Up on Reducing Improper Payments

CMS and the Treasury Department are going into business together, with the end goal of reducing improper payments. A recent CMS notice announced an upcoming computer matching program, in which the...

September 5, 2014

ACA Tax Rule Gets Rehearing By Federal Appeals Court

The full U.S. Court of Appeals for the District of Columbia Circuit will rehear a case on Affordable Care Act tax subsidies, a move that may reduce the chances of a new Supreme Court showdown...

September 3, 2014

Meaningful Use Relief Rule Doesn't Go Far Enough, Health IT Groups Say

The final rule intended to ease EHR certification requirements for meaningful use participants this year offers only temporary relief for those struggling to meet the program's requirements, health information technology industry associations said Sept. 2.

September 3, 2014

Will We Ever Get New RAC Contracts?

Seems like it was just yesterday that CMS said new RAC contracts would be in place by February of this year. That got delayed, of course, and now it looks like we're in store for more RAC contract...

September 3, 2014

Measuring Individual Docs for Quality May Not Be Worth Effort, MedPAC Says

Congress's Medicare advisers are urging the Centers for Medicare & Medicaid Services not to focus on the performance of individual physicians in the agency's quality measurement programs...

September 3, 2014

CMS Final Rule Allows Consumers to Automatically Re-Enroll for 2015 on HealthCare.gov

With the second open enrollment period of the Affordable Care Act scheduled to start Nov. 15 for the 2015 plan year, the Department of Health and Human Services’ Centers for Medicare &...

August 29, 2014

The Doc Fix is Still Cheap, Medicare Spending Will Slow, and Other CBO Predictions

CBO predicts Medicare spending will slow over the next decade. In the short-term, Medicaid spending will rise considerably because of states expanding coverage under the Affordable Care Act.

August 25, 2014

Healthcare Efficiency Index Highlights Savings From Administrative Simplification

Increased adoption of information technologies to process health-care claims electronically could save providers and payers $8 billion next year, according to a report by the Council for...

August 21, 2014

Study: 7 Million Could Get Affordable Care Act Coverage Outside of Open Enrollment

While the Obama administration has been proud of getting more than 8 million people to sign up for health coverage during the first open enrollment period of the Affordable Care Act, millions more...

August 20, 2014

Affordable Care Act Risk Sharing Rules May Give Taxpayers Unlimited Exposure, Report Says

Among the many hot-button issues involving the Affordable Care Act are risk sharing rules designed to protect health insurers from ending up with higher-than-average numbers of enrollees who have...

August 19, 2014

350,000 Who May Drop Coverage Would Buy Lower-Value Plans

Health insurers have suggested that the Affordable Care Act be amended to allow for more affordable plans that cover the same list of services but a lower share of claims. Aug. 18 the Council for...

August 19, 2014

Are Nursing Homes Doing Enough to Report Abuse Allegations?

Federal regulations require nursing homes to report any abuse and neglect allegations to the proper authorities, but it looks like barely half of nursing homes are actually doing this correctly. A...

August 18, 2014

Open Payments Is Back Online

Last Friday was a banner day for CMS, as it was finally able to put the Open Payments system back online. The database had been offline for 12 days (since Aug. 3) due to an investigation into a...

August 13, 2014

Health Data Exchange Stymied By ‘Lack of a Business Case,' Policy Group Says

The primary barrier to electronic health information exchange is “the lack of a business case” for doing so, according to a policy brief published Aug. 11 by Health Affairs.   Despite evidence...

August 13, 2014

Is the Sunshine Act on the Cusp of a Delay?

Last week CMS announced it was temporarily taking the Open Payments system offline, due to potential issues involving the review and dispute process for physicians. According to CMS, the review and dispute process, which was supposed to be finished by Aug. 27, will be adjusted for every day the Open Payments system is offline.

August 8, 2014

Proposed 2015 Health Insurance Premiums Up 7.5 Percent on Average

Average proposed health insurance premiums for 2015 are 7.5 percent higher than 2014, beating predictions from experts that they’d increase at a faster rate, PricewaterhouseCoopers LLP (PwC) reports....

August 8, 2014

Kitchen Sink Draft Bill Covers a lot of Anti-Fraud Territory

In an effort to add more teeth to Medicare fraud fighting, a Republican congressman has released a discussion draft bill packed with a kitchen's sink worth of provisions, including removing Social Security numbers from Medicare cards and mandating MACs to create provider outreach and education programs focused on lowering improper payments.

August 7, 2014

Are We Going to Have to Wait Six More Months for the Sunshine Report?

September is around the corner, bringing with it a new school year, football and the eagerly anticipated public report from the CMS Open Payments program. However, that deadline is being aggressively questioned by the American Medical Association and over 110 state medical groups and industry associations, which have called on CMS to push the report back to March 31, 2015. 

August 7, 2014

Balance Called For With Narrow ACA Networks

One of the hot topics about the Affordable Care Act is that it has led to more limited provider networks in the health plans sold through the ACA marketplaces. But a panel that briefed reporters on...

August 6, 2014

RACs Are Back, Albeit on a Limited Basis

Providers, it's time to get ready, because RAC audits are back. RACs have been on hiatus since a February suspension of the ability to request documents associated with claims reviews, but a recent CMS notification announced a limited restart of the program that could continue until new RAC contracts are awarded.

August 5, 2014

Medicare Won't Go Bankrupt Until 2030

The medicare part A Trust Fund won't go bankrupt until 2030 under new projections, but the entire Medicare system is still in dire need of reform.

August 5, 2014

Second Bundled Payment Experiment Fails, RAND Reports

The Affordable Care Act authorizes a wide variety of health care payment reforms intended to reduce cost and improve the efficiency and quality of the American health care system. One of the leading...

August 5, 2014

CMS Projects Inpatient Hospital Payments Will Decrease by $756 Million in FY 2015

Hospitals say the disproportionate share program cuts in the final Medicare payment rule issued by the Centers for Medicare & Medicaid Services Aug. 4 will hurt their ability to provide...

August 4, 2014

CMS Proposed Rule Would Result in Lower Subsidies, Milliman Finds

A proposed rule by the Centers for Medicare & Medicaid Services aimed at simplifying re-enrollment for the 8 million people who signed up for health insurance in the Affordable Care Act...

August 1, 2014

Is Change Afoot for the False Claims Act?

The winds of change may soon be blowing over the False Claims Act, courtesy of a proposal that would seek to increase the amount of self-reported FCA violations. I attended a Congressional hearing this past week that featured testimony from an attorney who said incentives should be added to the FCA to encourage companies to create certified compliance programs.

August 1, 2014

CMS Releases Three Medicare Payment Rules

The Centers for Medicare & Medicaid Services July 31 released three Medicare final payment rules for fiscal 2015 affecting nursing homes, inpatient rehabilitation facilities, and inpatient...

July 31, 2014

Group Health Plans That Don’t Comply With Affordable Care Act Could Be Continued Under Bill

With two votes from Democrats, the House Energy and Commerce Committee July 30 approved legislation that would allow health insurers to offer group plans that were in effect in 2013, including old...

July 31, 2014

Temporary Moratoria Are Back- At Least for Six More Months

If you're a home health agency or ambulance supplier looking to enroll in Medicare in the Houston area, you're out of luck, at least for the next six months. CMS recently announced it was extending temporary enrollment moratoria for HHAs and ambulance suppliers operating in several metropolitan areas.

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