iqtsupport, Author at DeBrunner & Associates

CMS to Watch the Watchdogs

The Centers for Medicare & Medicaid Services intends to pay closer attention to the work performed by accrediting organizations for different types of health care providers. With all providers and suppliers participating in Medicare subject to some kind of accreditation and inspection process, CMS intends to monitor more closely the work of those accreditors and inspectors after a 2018 Wall Street Journal investigation discovered facilities with continuing problems that continued to serve patients and keep their accreditation. With this in mind, CMS will redesign how accrediting organizations do their work, publicly post performance data on those accrediting organizations, and submit [...]

iqtsupport2018-10-12T06:00:19-04:00October 12, 2018|Medicare|

Physicians Push Back Against Medicare Telemedicine Proposal

A proposal to enable Medicare to make greater use of telemedicine as a means of serving patients is receiving surprising pushback from physicians. The Centers for Medicare & Medicaid Services has proposed paying doctors $14 for what would amount to a five-minute telephone “check-in” call with patients. Some physicians note that they already have such telephone conversations patients – and do not charge for those calls. Others fear the new service will increase their patients’ health care costs because they would incur a co-pay for such conversations. The chairman of the Medicare Payment Advisory Commission (MedPAC), himself a physician, has [...]

iqtsupport2018-10-11T13:00:46-04:00October 11, 2018|Centers for Medicare & Medicaid Services, Medicare regulations|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s October agenda were: managing prescription opioid use in Medicare Part D opioids and alternatives in hospital settings: payments, incentives, and Medicare data Medicare payment policies for advanced practice registered nurses and physicians Medicare’s role in the supply of primary care physicians Medicare payments for services provided in inpatient psychiatric facilities episode-based payments and outcome measures under a unified payment system for post-acute care Medicare policy issues related to non-urgent and emergency care MedPAC is an independent congressional [...]

iqtsupport2018-10-11T06:00:51-04:00October 11, 2018|Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

CMS: More Medicare Site-Neutral Payments Coming

The federal government is unlikely to stop with outpatient visits in its drive to make more Medicare payments on a site-neutral basis. That was the message Centers for Medicare & Medicaid Services administrator Seema Verma delivered at a public event last week. We are taking a look at [site-neutral payments] across the board and looking at our authority and where we can weigh in on it. But I think the post-acute space is something where there are a lot of differentials in payments and something we’re very interested in exploring. CMS recently proposed extending its use of site-neutral payments for [...]

iqtsupport2018-10-10T06:00:53-04:00October 10, 2018|Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Hospitals Ask Congress to Protect 340B Program

The leaders of more than 700 hospitals and health systems have written to congressional leaders to ask them to protect the section 340B prescription drug discount program. The letter states that We are concerned about recent regulatory actions that have reduced the reach of this vital program and by legislative proposals that would undo more than two decades of bipartisan work to preserve the health care safety net. The letter explains that In 2015, 340B hospitals provided $26 billion in uncompensated and unreimbursed care to low-income and rural patients in need. That represented 60 percent of all such care delivered [...]

iqtsupport2018-10-09T06:00:01-04:00October 9, 2018|340b|

Medicare Site-Neutral Outpatient Payment Proposal Would Have Disproportionate Impact

The Centers for Medicare & Medicaid Services’ proposal to make more Medicare outpatient payments on a site-neutral basis would significantly cut Medicare’s overall outpatient spending but most of that cut would be borne by just a few hospitals. A report prepared for the Integrated Health Care Coalition concluded that …CMS’ Off-Campus Site-Neutral Proposal in the FY 2019 CMS OPPS [note: outpatient prospective payment system] NPRM [note: notice of proposed rulemaking] will disproportionate affect about six percent of 3,333 hospitals that participate in the program. 200 hospitals will shoulder 73 percent of the proposed payment reductions….For the top 200, the average [...]

iqtsupport2018-10-05T06:00:43-04:00October 5, 2018|hospitals, Medicare regulations|

DSRIP Evolves

Medicaid Delivery System Reform Incentive Payment waivers, unleashed by the Affordable Care Act and other Obama administration initiatives, sought to foster a greater focus on value in the delivery of health care. Medicaid DSRIP waivers typically provided new Medicaid funds to health care organizations that met performance goals for improving the quality of care, improving health care outcomes, and improving health care infrastructure in ways that improved care quality and outcomes. To a significant extent, early DSRIP programs helped protect Medicaid payments to hospitals that were jeopardized by hospital-specific and state-wide upper-payment limit problems. State DSRIP initiatives are now moving [...]

iqtsupport2018-10-04T06:00:03-04:00October 4, 2018|Medicaid|

Verma Speaks at Medicaid Managed Care Summit

Centers for Medicare & Medicaid Services administrator Seema Verma recently addressed the Medicaid Managed Care Summit, which was held in Washington, D.C. Ms. Verma’s speech focused on four major areas: Empowering states to function as laboratories for innovation by giving them the flexibility to introduce changes that work best for their own citizens. Developing Medicaid and CHIP scorecards that present data on health outcomes, quality metrics, and CMS’s administrative performance. Improving Medicaid program integrity, including through “…targeted audits to ensure that provider claims for actual health care spending match what the [Medicaid managed care] health plans are reporting financially.” Strengthening [...]

iqtsupport2018-10-03T06:00:33-04:00October 3, 2018|Medicaid managed care|

OIG: Medicare Advantage Plans May be Denying Access to Save Money

The Office of the Inspector General of the U.S. Department of Health and Human Services is concerned that Medicare Advantage plans may be denying their members access to services to save money and increase profits. According to the OIG, those Medicare Advantage plans overturn 75 percent of their own denials of service upon appeal and independent reviewers are overturning still more denials. In the OIG’s view, this high rate of service denials raises concerns that Medicare Advantage plans, which today serve more than 20 million seniors, are denying their members access to needed medical services so they can cut costs [...]

iqtsupport2018-10-02T06:00:41-04:00October 2, 2018|Medicare|

New Approach to Readmissions Program to Take Effect October 1

Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals. The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve. The readmissions performance of hospitals is then compared only to other hospitals within each peer group. As [...]

iqtsupport2018-10-01T06:00:29-04:00October 1, 2018|Medicare, Medicare regulations|

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