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
August 29, 2014
by Nathaniel Weixel
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
by Alex Ruoff
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
by Sara Hansard
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...
by James Swann
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...
by Steve Teske
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
by Kendra Casey Plank
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...
The five-year anomaly of tempering health-care costs in the U.S. will end in 2015, PricewaterhouseCoopers LLP (PwC) said in a report on health-care market trends released June 24. In recent years...
June 24, 2014
CMS is not pulling any punches when it comes to oversight and enforcement over Medicare Part D and Part C plan sponsors, and the agency has the tools to make any violations hurt, a CMS official said at a recent conference I listened in on via a webcast.
June 23, 2014
Congressional Republicans as well as the nonpartisan Government Accountability Office and Congressional Research Service have questioned whether the Obama administration has legal authority to make...
June 20, 2014
Among the many important data points in dispute concerning the Affordable Care Act is how many of the enrollees in the ACA marketplaces were previously uninsured. Covering the uninsured, after all,...
June 19, 2014
The Affordable Care Act includes several provisions to keep premiums stable if health insurers end up with sicker-than-expected enrollees. Congressional Republicans have charged this could lead to a...
June 18, 2014
Prescription drug diversion is a growing problem for the health-care system, resulting in both financial loss and patient harm. Last week I sat down with Leslie Hollie, the OIG's assistant inspector general for investigations, to talk about common diversion schemes and the strategies the OIG is using to fight back.
June 17, 2014
Senior Medicare Patrols (SMPs) were responsible for $9 million in expected Medicare and Medicaid recoveries in 2013, a recent OIG report said, thanks to fraud, waste and abuse referrals passed on to CMS contractors.
June 16, 2014
One of the controversial elements of the coverage provided under the Affordable Care Act is that medical provider networks for which enrollees receive full coverage under the health plans are...
The Medicaid and CHIP Payment and Access Commission June 13 recommended Congress extend federal funding for the Children's Health Insurance Program for an additional two years. In its June...
Lawmakers are beginning to take notice of hospital concerns over the Medicare Hospital Readmissions Reduction program.
June 13, 2014
The controversial "narrow networks" featured in many of the Affordable Care Act marketplace health plans are likely to become more prevalent in the commercial market and in Medicare Advantage plans,...
June 12, 2014
My favorite Stark law exception, the in-office ancillary services exception (IOASE) is back in the news, thanks to a recent notice from CMS asking for comments on any burdens associated with the IOASE's disclosure requirement. Self-referring physicians offering imaging services are required to give patients a notice disclosing ownership interests in imaging equipment, and are also required to provide a list of five alternate imaging providers operating within a 25-mile radius.
June 10, 2014
The Centers for Medicare & Medicaid Services is making up to $60 million available for the next round of grants to support health-care navigators for certain states under the Affordable Care...
June 9, 2014
Conventional wisdom has it that self-referring providers are always going to refer more patients for services, but is this actually the case? Yes, according to a recent GAO report, but with a caveat or two.
June 6, 2014
The Congressional Budget Office (CBO), on which Congress relies for estimating the costs of legislation, June 5 reduced its estimate of the number of people who will end up paying penalties under...
of April, the federal government has paid more than $23.7 billion in incentive
payments to health-care providers and hospitals through the meaningful use program,
which pays Medicare and...
June 4, 2014
Continuing its assault on what it consider burdensome audit activities by the federal government, the American Hospital Association has asked the Health and Human Services Department to block future hospital compliance audits conducted by the HHS Office of Inspector General. A recent letter from the AHA to the HHS and the Centers for Medicare & Medicaid Services said the OIG reviews often overlap with Recovery Audit Contractor (RAC) reviews, presenting hospitals with an onslaught of contractors all asking to review the same records.
June 3, 2014
Much data remains to be revealed about the Affordable Care Act, and a key issue is whether it is resulting in greater health insurance coverage. The Kaiser Family Foundation (KFF) took a stab at...
The Department of Health and Human Services said June 3 it
is making up to $300 million available to community health centers to improve
the care they offer. The funding, included in the...
RACs have been operating nationally for several years now, but a question that's often asked is whether they're merely adding to the administrative burden facing hospitals rather than accomplishing their original mission by identifying and recovering overpayments. An answer to that question was included in the recent RACTrac survey from the American Hospital Association, which said said that 48 percent of hospitals reported spending over $25,000 to manage their RAC process during the first quarter of 2014, while 11 percent reported spending over $100,000.
May 30, 2014
The latest in a string of criticisms of the way the nation
pays for health care services came May 29 from a top technical advisory panel
to President Obama. The President’s Council of Advisors...
federal advisory group in July will offer recommendations to federal regulators
on the governance and structure of the proposed Health Information Technology Safety
Center, a central hub for...
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
SIGN UP FOR OUR FREE NEWSLETTERS >>>>