The Health Care Policy Blog is a forum for health care policy professionals
and Bloomberg BNA editors to share ideas, raise issues, and network with
September 22, 2014
by James Swann
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...
by Alex Ruoff
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
by Steve Teske
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. ...
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
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
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
by Kendra Casey Plank
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...
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...
by Sara Hansard
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...
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...
by Nathaniel Weixel
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
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...
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
September 8, 2014
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...
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 Republicans promise to pass a bill allowing employees to keep non-ACA compliant group health plans.
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...
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
September 3, 2014
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.
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...
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...
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
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
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
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
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
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...
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
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
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
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
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....
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
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.
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
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
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.
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...
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
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
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.
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
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...
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.
July 29, 2014
The likelihood Congress will move on
any bills this year—particularly health care legislation—is slim. But,
telehealth advocates are encouraged by what they see as growing bipartisan
July 25, 2014
In a story that seems to repeat itself over and over, the OIG has uncovered more improper Medicare payments, this time associated with Medicare administrative contractors (MACs).
July 24, 2014
More than 80 percent of health-care
organizations hired at least one health information technology expert in 2013,
an increase over previous years, according to a survey released July 22 by...
Health care providers want assurances that a proposal
intended to give them flexibility in the federal government’s electronic health
record incentive program won’t come back to bite them in...
July 23, 2014
We're less than two months out from the public release of Sunshine Act data, and while the initial data submissions have already been made, it's an ongoing process and the penalties for inaccuracy can be steep.
July 22, 2014
C ompeting federal court
decisions July 22 left up in the air whether federal subsidies provided
individuals enrolling in health insurance coverage under the Affordable Care
Act are legal....
July 21, 2014
Despite an adverse court decision, the federal government is
maintaining its position on how safety-net providers can receive discounts on
drugs that may have “orphan” uses. The HHS July 21...
July 18, 2014
The five U.S. territories have been forced to become an experiment in what happens when the guaranteed availability, community rating and other reforms of the Affordable Care Act are applied without...
The Department of Justice scored another win in the on-going fight against health-care fraud with the recent announcement of a guilty plea by an executive of Alpha Diagnostics, a supplier of portable x-ray services based in Owings Mills, Md.
July 16, 2014
It's official: Industry associations aren't happy with a recent proposal from the OIG increasing the agency's exclusion authority. Comment letters from the AMA, the AHA and PhRMA all took issue with the proposed rule, especially a provision that would abolish the current six-year statute of limitations for imposing exclusions on individuals or entities.
After surveying 843 programs that provided assistance to people enrolling in coverage through the Affordable Care Act health insurance marketplaces during the first open enrollment period in...
by John T. Aquino
BIO 2014 International Convention in San Diego last month, there was a strong
sense of optimism, along with acknowledgements of not-so-hidden dangers around,
which became more apparent on...
July 15, 2014
providers are generally unaware of the potential hazards posed by the use of health
information technologies, according to a research report published by the
Office of the National...
July 11, 2014
Finance Committee Chairman Ron Wyden (D-Ore.), and senior Finance Committee
member Chuck Grassley (R-Iowa), July 11 requested detailed pricing information
on the Hepatitis C virus drug...
The battle is really shaping up between RACs and hospitals and physicians, as evidenced by a recent Senate staff report and roundtable meeting. I was at the Senate Special Committee on Aging roundtable, where a range of participants representing both providers and RACs sparred over the effectiveness of the RAC program, and program integrity contractors in general.
Health insurance brokers have mounted an offensive to try to get their commissions excluded from administrative expenses that are limited under the Affordable Care Act. They have pointed to surveys...
July 10, 2014
There is no evidence suggesting hospitals are systematically using electronic health records (EHRs) to claim a sicker patient population through billing codes, or upcode, to increase Medicare...
July 8, 2014
Buried inside the 600-plus pages of the proposed 2015 Medicare physician fee schedule is a provision that on first glance looks major: CMS wants to excise an entire section of the Sunshine Act that grants reporting exemptions to manufacturers that fund continuing medical education events.
July 7, 2014
White House says states that haven't expanded Medicaid have missed out on $88 billion in federal funding.
July 3, 2014
Under the Affordable Care Act health insurers have limited options for reducing premiums in the individual and small group markets, since the law prohibits them from discriminating against people with medical conditions and it requires that a standard package of benefits be covered.
AHLA's annual meeting was so jam-packed with information that I can't resist one more blog post about it, if only to highlight what the OIG has been up to lately. Robert DeConti, the OIG's assistant inspector general for legal affairs, said medically unnecessary cardiac procedures have been on the OIG's radar screen of late
July 2, 2014
I just returned from two-action packed days in New York covering the AHLA's Annual Meeting, and one of my big takeaways is that provider grumbling over the RAC program are starting to gain some some traction within Congress.
July 1, 2014
health record systems certified for use in Stage 2 of the meaningful use
program aren't always interoperable with other EHR systems, according to a study published June 26 in the...
While the June 30 Supreme Court ruling that contraceptive coverage regulations implementing the Affordable Care Act's preventive services mandate for women violates the Religious Freedom...
June 30, 2014
reaction to the U.S. S upreme Court’s decision in the Hobby Lobby case June 30 broke down
along partisan lines, with Republicans praising the decision as a victory...
June 27, 2014
Hospital administrators expect that the anticipated conversion to the ICD-10 (International Classification of Diseases, 10th Revision) code set will immediately make a host of health IT activities...
I briefly touched on the recent CMS predictive modeling report in a previous blog post, but I think it merits a second post, if only to talk about the introduction of adjusted savings.
Change may be coming to
Medicare’s post-acute care system, but it may take a decade for it to arrive.
Leaders of the Senate Finance and House Ways and Means committees June 26
June 26, 2014
FDA proposes to
exempt medical device data systems from regulations because they pose a low risk to patients.
I headed up to the Hill yesterday for yet another Congressional hearing into Medicare fraud, waste and abuse, and as usual, the members weren't happy with the lack of progress CMS has made in protecting the program.
June 25, 2014
The Department of Health and Human Services Office of
Inspector General is warning clinical laboratories and physicians that
providing remuneration to physicians to collect, process and package...
Balance Called For With Narrow ACA Networks
Proposed 2015 Health Insurance Premiums Up 7.5 Percent on Average
Kitchen Sink Draft Bill Covers a lot of Anti-Fraud Territory
Is the Sunshine Act on the Cusp of a Delay?
Health Data Exchange Stymied By ‘Lack of a Business Case,' Policy Group Says
Employee Background Checks
Adverse Employment Action
Burden of Proof
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