Bulletin Board
Bulletin Board
CMS Outlines Improvements in RAC Audit Processes
In the face of complaints from hospitals about backlogs, time-consuming procedures, and lengthy appeals processes involving Medicare Recovery Audit Contractor audits, the Centers for Medicare & Medicaid Services recently outlined changes it has implemented in the RAC audit process to address these and other concerns. They are (in CMS's own words): Better Oversight of RACs We are holding RACs accountable for performance by requiring them to maintain a 95% accuracy score. RACs that fail to maintain this rate will receive a progressive reduction in the number of claims they are [...]
Are Savings Baked Into Medicare Advantage?
Medicare Advantage plans spend less for their members’ care than traditional Medicare – even when beneficiaries switch from traditional Medicare to a Medicare Advantage plan. This spending trend, moreover, applies to all types of Medicare beneficiaries, even after risk adjustment, regardless of age, gender, or dual-eligibility. It even applies to beneficiaries with chronic medical conditions, according to a recent study. Why the difference? The study’s authors suggest “favorable self-selection.” Past studies have suggested that Medicare Advantage plans’ care management components are responsible for reduced costs but this study casts that [...]
New Client
DeBrunner & Associates is pleased to welcome our newest client: the University of Pittsburgh Medical Center. As Pennsylvania’s largest non-governmental employer, with more than 87,000 employees, UPMC consists of more than 30 hospitals, more than 700 doctors' offices and outpatient sites, an international division, and an enterprises division. Welcome!
CMS Adopts Rule to Protect Medicaid Payments
A new Medicaid provider payment reassignment regulation eliminates the ability of states to divert any portion of Medicaid payments to third parties. Such diversion was authorized, in a limited manner, in 2014, when CMS created an exception to the existing prohibition on the diversion of provider payments to third parties. That exception involved diversion of payments to selected third parties, mostly in-home personal care workers, but in this new, final regulation, the agency eliminates this exception, maintaining that it is inconsistent with the Social Security Act. Learn more about the [...]
CMS Solicits Waiver Input From Stakeholders
The Centers for Medicare & Medicaid Services is soliciting ideas from stakeholders about new approaches that might be employed in the development of state relief and empowerment waivers, also known as section 1332 waivers. Last year CMS loosened section 1332 waiver requirements and offered states four concepts for how to take advantage of both the waivers and the less stringent requirements. Section 1332 waivers permit states to seek exemption from selected requirements of the Affordable Care Act to pursue new approaches to enhancing access to quality, affordable health insurance. Through [...]