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
April 18, 2014
by Nathaniel Weixel
The FDA is discouraging the use of a common hysterectomy procedure because of the risk of spreading cancer.
by James Swann
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
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
by Alex Ruoff
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...
by Sara Hansard
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...
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
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
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.
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.
by Steve Teske
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
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
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
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...
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
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.
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
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
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
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
by Kendra Casey Plank
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...
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.
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
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
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.
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
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...
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."
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
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
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 ...
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.
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
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...
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
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.
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
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...
Many of the Medicare proposals in the White House FY 2015 budget request are the same as last year.
March 7, 2014
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...
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
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).
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...
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
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.
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
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
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
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.
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
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.
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
FDA is requiring manufacturers to submit electronic adverse event reports starting in 2015.
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.
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
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...
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...
by John T. Aquino
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
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
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
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...
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
New CMS final rule makes it easier for patients to access test results from medical labs directly.
February 4, 2014
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,...
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...
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...
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
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...
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...
How much can a clinician’s gender and attitude dictate how
easily they will adopt new health information technologies? A lot, according to
published in the January edition of the...
January 30, 2014
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...
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
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...
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
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...
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...
CBO Lowers Estimate of Health Insurance Gains under Affordable Care Act
Benficiary Beware: Medicaid May Be Sharing Your Information Outside the U.S.
Electronic Fund Transfers Growing Over Expectations
Is Medicare Actually Paying Claims for People Who've Been Kicked Out of the Program?
Is Budget Neutrality Getting in the Way of Serious CMS Savings?
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