iqtsupport, Author at DeBrunner & Associates

Some Surprise Billing Dispute Decisions to Resume

The Independent Dispute Resolution entities empowered by the No Surprises Act of 2020 to adjudicate disagreements between providers and payers may resume their work – but only some of it. According to the Centers for Medicare & Medicaid Services, On February 24, 2023, certified IDR entities were instructed to resume processing payment determinations on February 27, 2023, for disputes involving items or services furnished before October 25, 2022. But CMS also announced that Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further [...]

iqtsupport2023-02-28T06:00:13-05:00February 28, 2023|Uncategorized|

The Emergence of “Food as Medicine”

In both the public and private sectors, a growing movement is working to integrate food as part of medical treatment – and have health care payers foot the bill. From the administration’s granting of Medicaid waivers to Arkansas, Massachusetts, and Oregon to use state and federal money to pay for food for some beneficiaries to Congress tucking $2 million into an appropriations bill for a “food is medicine pilot program” to the NIH developing a $140 million grant program that will lead to the designation of “food is medicine centers of excellence,” providers and policy-makers are showing unprecedented interest in [...]

iqtsupport2023-02-27T06:00:08-05:00February 27, 2023|health equity, Medicaid, Medicare, social determinants of health|

Federal Health Policy Update for February 23

The following is the latest health policy news from the federal government for February 17-23. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has issued an informational bulletin to states reiterating certain federal requirements that pertain to health care-related taxes. Recently, CMS became aware that some health care-related tax programs appear to involve agreements among providers to redistribute their Medicaid payments to hold taxpayers harmless for the cost of the tax. The bulletin reminds states that such arrangements are prohibited. Find the CMS bulletin here. CMS has posted a [...]

iqtsupport2023-02-23T15:53:32-05:00February 23, 2023|Accountable Care Organization, ACO, Alternative payment models, COVID-19, Medicaid, Medicare, Telehealth|

Most Medicaid Participants Don’t Know About Looming Eligibility Redetermination

With the COVID-19 pandemic’s continuous Medicaid eligibility set to expire in a little more than a month, nearly two-thirds of the current Medicaid population is unaware their continued participation in the program will soon be subject to review and could result in their loss of health care benefits. According to a survey conducted for the Robert Wood Johnson Foundation, “In December 2022, more than 6 in 10 adults in Medicaid-enrolled families were not aware of an upcoming return to the regular Medicaid renewal processes…” This could pose a major challenge both for those who lose their Medicaid coverage and may [...]

iqtsupport2023-02-23T06:00:41-05:00February 23, 2023|Medicaid|

End of PHE Spells End of Additional Money to Care for COVID Patients

When the COVID-19 public health emergency ends on May 11, the 20 percent increase in Medicare payments to hospitals caring for Medicare patients suffering from the disease will end as well. In the first two years under this payment policy, which took effect in January of 2020, the federal government paid more than $23 billion to hospitals caring for COVID patients. Of that amount, 20 percent consisted of the supplemental payment. Learn more about the end of these additional payments and what it may mean for hospitals and Medicare beneficiaries from the Becker Hospital Review article “The 20% cut coming [...]

iqtsupport2023-02-22T06:00:27-05:00February 22, 2023|COVID-19, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for February 16

The following is the latest health policy news from the federal government for February 6-16. Some of the language used below is taken directly from government documents. No Surprises Act A federal judge in Texas has vacated parts of a regulation governing the arbitration process that is a major aspect of implementation of the No Surprises Act. In his ruling, the judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis on the qualified payment amount (QPA) that is a major part of the arbitration process. The decision explains that “The Court first [...]

iqtsupport2023-02-16T17:02:31-05:00February 16, 2023|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations|

Surprise Billing Law Stumbles in Court

A federal judge in Texas has vacated part of the arbitration process that is a major aspect of the No Surprises Act, the federal law enacted to reduce surprise medical bills. In the wake of this ruling, the Department of Health and Human Services has directed the entities charged with mediating payment disagreements to stop making decisions. In the Texas case challenging the fairness of the independent dispute resolution process that is a key component of the surprise billing law’s implementation, the federal judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis [...]

iqtsupport2023-02-14T06:00:22-05:00February 14, 2023|Uncategorized|

Federal Health Policy Update for February 6

The following is the latest health policy news from the federal government for the week of January 23 to February 6. Some of the language used below is taken directly from government documents. 340B Pharmaceutical companies may restrict the ability of providers to use specialty and community pharmacies to distribute 340B-covered drugs, a federal appeals court has decided. See the court’s ruling here. Centers for Medicare & Medicaid Services CMS has revised its fact sheets about COVID-19 public health emergency waivers and flexibilities for different types of providers, updating which waivers and flexibilities have already been terminated, which have been [...]

iqtsupport2023-02-06T17:03:31-05:00February 6, 2023|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC|

“Hospital at Home” Growing

The concept of treating “hospitalized” patients at home could play a more prominent role in the delivery of hospital services in the coming years. Hospital at home programs have been around for decades but took on greater importance when COVID-19 began filling hospital beds. With many communities experiencing a shortage of beds, the Centers for Medicare & Medicaid Services issued an “acute hospital care at home waiver” in November of 2020 to help compensate for the bed shortage and encourage home programs. Now that the COVID crisis has passed, health care interests are not necessarily moving away from the idea [...]

iqtsupport2023-02-01T06:00:05-05:00February 1, 2023|hospitals, Medicare, Medicare regulations|

Hospitals Improving Electronic Data Exchange

Hospitals are improving their interoperability and doing a better job of exchanging health data electronically, according to a review by the federal Office of the National Coordinator for Health Information Technology (ONC). According to a new ONC report, In 2021, more than 6 in 10 hospitals engaged in key aspects of electronically sharing health information (send, receive, query) and integrating of summary of care records into EHRs, a 51 percent increase since 2017. Availability and usage of electronic health information received from outside sources at the point of care significantly increased over the last four years, reaching 62 and 71 [...]

iqtsupport2023-01-31T06:00:22-05:00January 31, 2023|Uncategorized|

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