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April 18, 2014

FDA Warns of Cancer Risk From Common Hysterectomy Technique

The FDA is discouraging the use of a common hysterectomy procedure because of the risk of spreading cancer.

April 18, 2014

Is Budget Neutrality Getting in the Way of Serious CMS Savings?

Budget-neutrality rules may be good for controlling the deficit, but they are making it impossible for CMS to realize $15 billion in savings from reducing hospital outpatient payment rates, according to a recent OIG report. The OIG said that CMS could save $15 billion between 2012 and 2017 if outpatient payment rates for ambulatory-surgical center (ASC)-approved procedures were reduced to ASC levels.

April 17, 2014

Is Medicare Actually Paying Claims for People Who've Been Kicked Out of the Program?

It seems like an obvious arrangement. If you're enrolled in Medicare, Medicare will pay for your claims, if you're not enrolled, they won't. As obvious as that might seem, a recent OIG report discovered that Medicare made $18.4 million in improper payments between 2010 and 2012 on behalf of patients who had been terminated from participating in the program.

April 15, 2014

Electronic Fund Transfers Growing Over Expectations

More than 8 million electronic fund transfers (EFTs) totaling $45 billion were made through the Automated Clearing House (ACH) Network in January, the Centers for Medicare & Medicaid Services...

April 15, 2014

CBO Lowers Estimate of Health Insurance Gains under Affordable Care Act

The Congressional Budget Office once again lowered its estimate of the number of people expected to gain health insurance under the Affordable Care Act.  In an April 14 report , the CBO projected...

April 15, 2014

Benficiary Beware: Medicaid May Be Sharing Your Information Outside the U.S.

While it's no secret that companies in the private sector routinely outsource administrative functions to foreign contractors, it may come as a surprise that some Medicaid agencies are also engaged in offshore outsourcing. In fact, there are no federal regulations preventing offshore outsourcing, and seven state Medicaid agencies are currently offshoring some of their administrative functions, according to a recent OIG report.

April 11, 2014

OIG to Physicians: Document Your Face-to-Face Encounters

Even though Medicare is supposed to reject home health claims that don't include documentation that a physician conducted a face-to-face encounter to certify patient eligibility, it instead inappropriately paid $2 billion for home-health claims that were missing documentation between January 2011 and December 2012, according to a recent OIG report. The report said 32 percent of all home-health claims requiring the face-to-face encounter either had no documentation, or included documentation missing required information such as a physician's signature or the date of the face-to-face encounter.

April 10, 2014

File Under More of the Same: OIG Releases Another Report on Questionable Medicare Billing

There are few things in life that are certainties, beyond the cliched death and taxes, but OIG reports uncovering potential Medicare fraud are fast climbing up the list. A recent report discovered that physicians billed Medicare $139 million for questionable electrodiagnostic tests in 2011.

April 10, 2014

Which Providers Will Have Star Power?

CMS is creating a five-star ranking system for hospitals, home health and dialysis providers. Providers are wary because the agency doesn't appear to have many details worked out yet.

April 10, 2014

CMS Warns Against Snap Judgments About Physician Payment Data

The Centers for Medicare & Medicaid Services April 9 urged caution about drawing quick conclusions about potential fraudulent or wasteful activities by providers who received particularly high...

April 9, 2014

Outlook is Positive for Competitive Bidding, But More Monitoring Needed, OIG and GAO Say

Medicare's durable medical equipment competitive bidding program is generally in compliance with federal requirements and is reducing DME utilization, but continued monitoring and oversight are needed to ensure patient access isn't compromised, according to recent reports from the OIG and GAO.

April 8, 2014

Think Tank to Recommend Long-Term Care Solutions

A public policy center is tackling the difficult policy question of how to provide long-term care services to millions of aging baby boomers in the coming years without bankrupting Medicaid, which...

April 4, 2014

State Health Insurance Marketplace Directors Questioned About Problems

The directors of five Affordable Care Act state health insurance marketplaces that had major technical problems were hauled before Congress at an April 3 hearing to explain what went wrong.  They...

April 4, 2014

Despite Payment Decreases Quality Reporting, eRx Incentive Programs Continue to Expand

Participation in the Medicare Physician Quality Reporting System (PQRS) and the Electronic Prescribing Incentive (eRx) Program grew by more than 151,000 providers between 2011 and 2012 even as...

April 3, 2014

SGR Law is a Big Win for Clinical Labs

Clinical labs and diagnostic test manufacturers scored a major victory when the SGR law updated the antiquated method Medicare pays for diagnostics with what stakeholders say is a much-needed boost of transparency.

April 3, 2014

Compliance Comes to San Diego: Inside the Recent HCCA Compliance Institute

San Diego may be known for perfect weather and gorgeous beaches, but this past week it became the epicenter of health care compliance, courtesy of the Health Care Compliance Association's Compliance Institute. I had the opportunity to attend and also participate as a speaker as part of a Bloomberg BNA panel on how the media covers health care fraud and abuse and compliance issues.

April 1, 2014

House Budget Plan Recycles Health Care Proposals

The fiscal 2015 budget blueprint released by House Republicans April 1 again proposes to repeal the Affordable Care Act, turn Medicaid into a block grant program, and remake Medicare based on a...

March 31, 2014

Hospitals Get Slow Start on Stage 2 Of Meaningful Use Program

No hospitals have yet attested to meeting the requirements of Stage 2 of the meaningful use program, Elizabeth Holland, director of health information technology initiatives at the Centers for...

March 28, 2014

Glaring Gaps Found in CMS Database of Terminated Providers

Most state Medicaid agencies would agree that accessing a comprehensive database of terminated providers is a good thing. So would CMS. Why then is the actual database (the Medicaid and Children's Health Insurance Program State Information Sharing System) so lacking in information? According to a recent report from the OIG, one of the chief culprits is that states are not required to submit records on terminated providers to MCSIS; instead, CMS just encourage them to.

March 27, 2014

Putting the Brakes on ICD-10

For months, federal regulators have insisted the nation’s health care system would indeed move forward with implementing the massive new ICD-10 code set in October. But a bill passed March 27 in...

March 27, 2014

Is ICD-10 Going to Be Delayed, Again?

I took the highway up to Charm City (aka Baltimore) yesterday for an AHLA conference, and I was a bit surprised to hear that ICD-10 might be delayed once again. Marc Hartstein, the director of CMS's Hospital and Ambulatory Policy group, said that while "ICD-10 is going forward at this particular point in time", activity on Capitol Hill might result in a further delay.

March 27, 2014

Obama Administration Again Delays Affordable Care Act Provision

Once again the Obama administration has backtracked on its repeated assertions that it would not delay implementation of the controversial Affordable Care Act. March 26 it released guidance giving...

March 26, 2014

House Republicans Unveil Temporary Doc Fix

Chances are dwindling that Congress will pass legislation permanently fixing Medicare’s physician payment system, at least this year. House Republicans March 25 unveiled legislation to extend...

March 21, 2014

Provider Groups to Congress: Hands Off Our Stark Law Exceptions

A group of 31 provider associations, including the American Medical Association and the American College of Cardiology, urged Congress not to limit the Stark law's in-office ancillary services exception (IOASE), according to a recent letter sent to the Senate Finance Committee and the House Ways & Means and Energy and Commerce Committees.

March 21, 2014

The Rarity of Health IT-Related Recalls

A recently announced Class I recall of a McKesson Corp. clinical decision support system by the Food and Drug Administration is noteworthy both for its potential impact on the health information...

March 20, 2014

HHS Posts Wide Range of Affordable Care Act Requirements

In a massive regulatory dump, the Department of Health and Human Services March 14 filed a 279-page proposed rule, an interim final rule and three other guidance documents on a wide range of...

March 20, 2014

Are the Two-Midnights Policy and RACs Behind Medicare's Appeals Backlog?

Medicare is currently facing a backlog of 375,000 pending claims appeals, and the two-midnights policy and the RAC program may be a big part of the problem, according to a recent letter from Rep. Jim McDermott (D-Wash.) to HHS Secretary Kathleen Sebelius. According to the letter, "the backlog in appeals must be addressed and to effectively address the backlog, the primary drivers of potential increases in Medicare appeals must be addressed, including the two midnights policy and the [RAC] program."

March 20, 2014

CMS Offers Choices for Hospice Patients

A new CMS pilot program will allow hospice patients to receive end-of-life care while also being treated to cure their disease/condition.

March 19, 2014

Senate Doc Fix Bill Would Cost $180 Billion, CBO Says

A revised Senate bill (S. 2110) to permanently repeal and replace Medicare’s physician reimbursement system would cost $180.2 billion over the period 2014-2024, according to an estimate by the...

March 14, 2014

MA Program Thriving Despite ACA Cuts, MedPAC Says

Payment cuts to Medicare Advantage plans contained in the Affordable Care Act have yet to impact the health of the program, according to the Medicare Payment Advisory Commission. In its annual March ...

March 14, 2014

Fun with ICD-10

Today I'm going to take a little break from the more serious health policy issues and focus on some fun with ICD-10. I went to HCCA's first-ever regional conference in DC, and was entertained by a presentation from D. Scott Jones, a senior vice president at HPIX, a provider of physician medical professional liability insurance.

March 14, 2014

American Smartphone Use to Capture mHealth Market Share

The United States is expected to hold the world’s largest share of the mobile health market through 2017 thanks to its high rate of smartphone use, according to a March 13 report by the Brookings...

March 12, 2014

Health Insurance Enrollment Under Affordable Care Act Reaches 4.2 Million

Enrollment in health insurance through the online marketplaces created by the Affordable Care Act reached 4.2 million March 1, the Department of Health and Human Services announced March 11. That...

March 12, 2014

Overpayments Continue to Plague Medicare, OIG Finds

While outright fraud might get more headlines, overpayments due to incorrect billing continue to bedevil the Medicare program, according to three recent OIG reports. This time the culprits are three member hospitals of the CHRISTUS Health network that the OIG said  received roughly $3.3 million in Medicare overpayments between January 2010 and June 2012.

March 11, 2014

Taking a Bite Out of Crime: Medicaid Fraud Fighters Recover $2.5 Billion in FY 2013

Fiscal year 2013 turned out to be a banner year for fighting Medicaid fraud, as state Medicaid Fraud Control Units (MFCUs)  recovered almost $2.5 billion associated withe criminal and civil investigations.

March 11, 2014

Percentage Without Health Insurance Continues to Fall, Gallup-Healthways Finds

The Gallup-Healthways Well-Being Index poll gave a boost to the Affordable Care Act March 10 with its findings that the percentage of Americans without health insurance continued to fall, to 15.9...

March 10, 2014

Number of Medicare Enrollees To Rise By One-Third by 2024, CBO Says

Mirroring an increase in the number of Americans reaching age 65 over the next decade, the Congressional Budget Office says the number of Medicare beneficiaries will rise by more than one-third...

March 10, 2014

White House Budget Rehashes Medicare Ideas.

Many of the Medicare proposals in the White House FY 2015 budget request are the same as last year.

March 7, 2014

People With Non-Compliant Policies Given Two-Year Reprieve From Health Care Law

Individuals and small businesses whose health insurance policies were cancelled for not meeting the requirements of the Affordable Care Act were given a two-year reprieve under guidance released...

March 7, 2014

Is It OK for Third-Party Premium Assistance in the Insurance Exchanges?

Since last fall, there has been a lingering question over whether a third-party can pay premiums for individuals enrolled in health plans offered on state and federal insurance exchanges. An interim final rule that recently arrived at the Office of Management and Budget soon might help answer that question.

March 5, 2014

Obama Budget Proposal Calls for More Money, New Tactics in Anti-Fraud Fight

If presidential budget proposals automatically became law, then the fraud-fighting Health Care Fraud and Abuse Control (HCFAC) account could expect a 9 percent increase in discretionary spending over the estimated fiscal year 2014 level ($294 million to $319 million).

March 5, 2014

White House Expresses Support For Congressional Doc Fix Efforts

The White House has lent its support to congressional efforts to overhaul Medicare’s problematic physician payment system. In its fiscal 2015 budget plan released March 4, the White House said it...

March 5, 2014

Mobile Devices Present But Not Contributing to EHRs, HIMSS Survey Says

Although most health-care providers want to be able to use their laptops, smartphones and other mobile devices to access and modify their patients’ health records, only a fraction of health-care...

February 28, 2014

Is CMS Doing a Good Job Screening Providers for Fraud?

With providers eligible for significant incentive payments related to their deployment of electronic health records technology, it's crucial that screening procedures are in place that can detect fraud and stop payments.

February 28, 2014

Bicameral Doc Fix Bill Would Cost $138B, CBO says

The Congressional Budget Office said Feb. 27 that bicameral, bipartisan legislation (S. 2000, H.R. 4015) to repeal and replace the Sustainable Growth Rate formula of Medicare’s physician payment...

February 27, 2014

Government Rakes in $4.3 Billion from Anti-Fraud Efforts

Fiscal year 2013 was a banner year for the federal government, with anti-fraud efforts resulting in $4.3 billion in recoveries, according to the recent Health Care Fraud and Abuse Control (HCFAC) program report.

February 26, 2014

At HIMSS in Orlando: Interoperability at Center of Discussions

One of the many buzz words of this year’s Healthcare Information and Management System Society’s (HIMSS) Conference has been interoperability. Many of the more than 36,000 vendors and health-care...

February 25, 2014

Physicians and Hospitals Urge HHS to Slow Down on Meaningful Use

A coalition of 48 provider organizations, including the American Medical Association and American Hospital Association, recently urged HHS to delay deadlines for Stages 1 and 2 of the electronic health record meaningful use program through 2015.

February 25, 2014

CMS Seeks Comments on Expanded DME Competitive Bidding

The Centers for Medicare & Medicaid Services is seeking public comment on how best to expand its competitive bidding program for durable medical equipment to more regions around the country....

February 20, 2014

CMS Calls Timeout on RAC Document Requests

In a move sure to please providers, CMS has pushed the pause button on the RAC program, suspending additional documentation requests (ADRs) until it completes the procurement process for new RAC contracts.

February 20, 2014

States Spend One-Third of Medicaid Money On Small Fraction of Beneficiaries, GAO Says

States are spending nearly one-third of their Medicaid money on the most expensive beneficiaries, who are just a small fraction of the total Medicaid population, according to a report released...

February 19, 2014

Device Reporting Goes Electronic

FDA is requiring manufacturers to submit electronic adverse event reports starting in 2015.

February 19, 2014

Congress to CMS: Time to Fix the RAC Program

The Recovery Auditor Contractor program has been a magnet for criticism since it became operational in 2005, and a bipartisan group of 111 congressmen has recently joined the party. In a letter to HHS Secretary Kathleen Sebelius, the congressmen called for stronger program oversight as well as a reduction in the backlog of pending RAC appeals.  

February 19, 2014

Bipartisan Group of 40 Senators Asks CMS To Avoid MA Cuts in 2015

Medicare Advantage payment rates for 2015 are due out Feb. 21, and the possibility that the Centers for Medicare & Medicaid Services will cut plan payments has got the attention of lawmakers....

February 18, 2014

Patient Advocates Celebrate Five Years of HITECH

Five years after the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law, one patient advocacy organization said health IT tools have become essential...

February 18, 2014

Has ICD-10 Implementation Just Gotten A Lot More Expensive?

Physician practices were always aware that transitioning to the new ICD-10 codeset would be expensive, but a recent report commissioned by the American Medical Association estimates the costs might...

February 18, 2014

Personalizing the Treatment of Cancer

A panel discussion at a conference I covered Feb. 14 provided intriguing insights about personalized medicine’s promise for treating cancer. Like so many others, I had a loved one who painfully but...

February 14, 2014

Heavy Female Concentration More a Worry Than Lack of Young Adults in ACA Marketplaces

Despite the heavy focus on whether the Affordable Care Act health insurance marketplaces are getting enough young enrollees to help keep health costs and premiums low, that may not be as much of a...

February 10, 2014

AHRQ Pushing for Health IT Safety Research

The Agency for Healthcare Research and Quality says it will use some of the $4 million it has appropriated for health IT research this year to support projects that examine the “high impact”...

February 6, 2014

House, Senate Lawmakers Unveil Permanent Doc Fix; Payfors Still Unknown

I would not break out the champagne just yet...still, the announcement today that House and Senate lawmakers have reached an agreement to eliminate the sustainable growth rate formula in the...

February 6, 2014

Is Change Coming to the 340B Program?

It looks like change might be in the wind for the 340B drug pricing program, after a recent OIG report found inconsistencies in how program participants determine if individuals qualify for the...

February 5, 2014

CMS Gives Patients Access to Lab Test Results

New CMS final rule makes it easier for patients to access test results from medical labs directly.

February 4, 2014

Regulatory Uncertainty Remains in the Health Software Market

The SOFTWARE Act ( H.R. 3303 )  introduced last fall by Rep. Marsh Blackburn (R-Tenn.) was intended to relieve regulatory uncertainty for health care software developers. Response to the bill,...

February 4, 2014

Medicare Spending Rose by Just 2 Percent in 2013, CBO says

Medicare spending grew by just 2 percent in 2013, the lowest rate since 1999, the Congressional Budget Office said Feb. 4 In a report on the federal budget and the economy, the CBO projected...

February 4, 2014

OIG Work Plan Includes Focus on Insurance Exchanges

At long last, the OIG's fiscal year 2014 work plan is out, and the state and federal insurance exchanges can expect some special attention over the next few months. The OIG said it will review...

February 4, 2014

Fraction of Physicians Will Avoid Stage 2 of Meaningful Use

More than 10 percent of office-based physicians are not planning to participate in Stage 2 of the meaningful use program, according to a Centers for Disease Control and Prevention survey. The...

January 31, 2014

Medicare Ups the Ante on Temporary Enrollment Moratoria

For only the second time ever, Medicare has issued temporary enrollment moratoria for home health agencies operating in Fort Lauderdale, Fla., Dallas, Houston and Detroit, as well as for...

January 31, 2014

CMS Touts ACO Success, Says Providers Saving Money While Improving Quality

The Centers for Medicare & Medicaid Services said this week that Accountable Care Organizations are beginning to bend the health care cost curve while at the same time improving the quality of...

January 31, 2014

The Right Attitude for EHR Adoption

How much can a clinician’s gender and attitude dictate how easily they will adopt new health information technologies? A lot, according to a study published in the January edition of the...

January 30, 2014

Obama’s State of the Union Health Care Remarks

While President Barack Obama staunchly supported the Affordable Care Act in his State of the Union address Jan. 28, ACA opponents noted that he didn't get to his signature 2010 law until more than...

January 30, 2014

Personalized Medicine Extends into Wellness

The promise of personalized medicine has prompted life sciences companies and medical researchers to continue to pursue the next logical step—into wellness. Personalized medicine is usually defined...

January 29, 2014

Medicare Strike Force Operating on All Cylinders

Fiscal year 2013 was a record year for the Medicare Fraud Strike Force program, which continues to put a dent in fraud eight years after its inception. According to a recent release from the...

January 29, 2014

Courts Strive to Balance Competing Interests

A recent order on attorneys’ motion to withdraw in a patent infringement case involving a cancer treatment system highlighted for me the challenge courts face in balancing competing interests. In ...

January 28, 2014

Only 11 Percent of Health Insurance Enrollees Previously Uninsured

The Affordable Care Act was aimed at reducing the number of people without health insurance in the United States.  So perhaps the most important statistic for its first open enrollment period from...

January 28, 2014

Is Medicare Mailing Statements to the Right Addresses?

Return to Sender may be a great song, but it's not something you want to see on mail you've sent out for delivery, especially if you happen to be Medicare. Unfortunately, that's been happening to...