Medicare regulations

Stark Changes Coming to Facilitate Value Care?

At a Washington, D.C. conference, Centers for Medicare & Medicaid Services Administrator Seema Verma announced that changes coming in Stark law requirements will enable Medicare to make better use of value-based purchasing in its reimbursement system. In addition to addressing cybersecurity and electronic health record system issues, changes in the anti-self-referral law will seek to facilitate better coordination of care for Medicare patients. Verma explained the underlying rationale for the anticipated changes, noting that …in a system where we’re transitioning and trying to pay for value, where the provider is ideally taking on some risk for outcomes and cost overruns, [...]

iqtsupport2019-03-07T06:00:54-05:00March 7, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy|

800 Hospitals Face Medicare Penalties

800 hospitals will see their Medicare payments reduced one percent this year because they are among the 25 percent of hospitals in the U.S. with the highest rate of hospital-acquired conditions. Among the 800 hospitals are 110 that are being penalized for the fifth year in a row. Medicare’s hospital-acquired condition reduction program tracks a variety of medical problems, including infections, blood clots, sepsis, hip fractures, bedsores, and others. Every year, the 25 percent of eligible providers – the program excludes significant numbers of hospitals – are penalized even if their performance for hospital-acquired conditions is superior to the previous [...]

iqtsupport2019-03-05T06:00:59-05:00March 5, 2019|hospitals, Medicare, Medicare regulations|

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services. In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments. Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided. Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities. Hospitals argue that their outpatient facilities are [...]

iqtsupport2019-01-30T06:00:38-05:00January 30, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, Medicare reimbursement policy|

MedPAC: Overhaul Medicare Quality Programs

Medicare would implement major changes in its hospital quality programs under a proposal approved by the Medicare Payment Advisory Commission. Fierce Healthcare reports that the proposal adopted by MedPAC for recommendation to Congress and the Centers for Medicare & Medicaid Services …would essentially lump together several existing programs that measure quality—the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program and the Hospital-Acquired Condition Reduction Program—into the Hospital Value Incentive Program (HVIP). It would also eliminate the existing Inpatient Quality Reporting Program. Under the MedPAC proposal, Performance across five domains—readmissions, mortality, spending, patient experience and hospital-acquired conditions—would be converted to HVIP “points.” Those points would be [...]

iqtsupport2019-01-25T06:00:15-05:00January 25, 2019|Medicare, Medicare regulations, Medicare reimbursement policy|

CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations. The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach. A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending. Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems. Greater flexibility to innovate [...]

iqtsupport2018-12-31T06:00:14-05:00December 31, 2018|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare regulations, Medicare reimbursement policy|

Readmissions Program Failing Some Heart Patients?

The 30-day mortality rate has risen for heart failure patients since Medicare’s hospital readmission reduction program was implemented. According to a new study published in JAMA, the 30-day mortality rate for heart failure patients rose 0.49 percent between 2007-2010 and 2010-2012 and another 0.52 percent between 2010-2012 and 2012-2015. Similar results were not found for the other types of patients whose readmission rates are measured under the program: patients who were hospitalized for heart attacks, heart bypass surgery, pneumonia, chronic obstructive pulmonary disease, and hip or knee replacement. The heart failure findings, though, raise the question of whether performance under [...]

iqtsupport2018-12-28T06:00:49-05:00December 28, 2018|Medicare regulations, Medicare reimbursement policy|

CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform. CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details. See a brief notice about the new office here.

iqtsupport2018-12-26T09:51:55-05:00December 26, 2018|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

HIPAA Overhaul Coming?

The U.S. Department of Health and Human Services has issued a request for information about stakeholders’ views on regulations implementing the Health Insurance Portability and Accountability Act, popularly known as HIPAA, leading to conjecture that the administration may be planning to revise the federal government’s application of the federal health care privacy law enacted in 1996. According to an HHS news release, “This RFI is another crucial step in our Regulatory Sprint to Coordinated Care, which is taking a close look at how regulations like HIPAA can be fine-tuned to incentivize care coordination and improve patient care, while ensuring that [...]

iqtsupport2018-12-17T06:00:58-05:00December 17, 2018|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

For Nursing Homes, Medicare Giveth and Medicare Taketh Away

Nearly 4000 skilled nursing facilities will receive bonuses from Medicare this year while nearly 11,000 will be penalized under Medicare’s Skilled Nursing Facility Value-Based Purchasing Program. The program, created in 2014, rewards nursing homes that keep low the number of patients who must be admitted to hospitals during the year and penalizes those with the highest hospital admission rates. Successful nursing homes will receive bonuses of as much as 1.6 percent for each Medicare patient they serve while those that had too many hospital admissions will face penalties of nearly two percent for all of their Medicare patients. On the [...]

iqtsupport2018-12-12T06:00:03-05:00December 12, 2018|Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

OIG Cites “Vulnerabilities” in Medicare Wage Index System

The Office of the Inspector General of the U.S. Department of Health and Human Services has “…observed significant vulnerabilities in the [Medicare area] wage index system…” As a result of these vulnerabilities, Medicare has overpaid 272 hospitals by more than $140 million over the past 13 years. The vulnerabilities the OIG identified that contributed to these overpayments are: absent misrepresentation or falsification, CMS lacks the authority to penalize hospitals that submit inaccurate or incomplete wage data; Medicare Administrative Contractors’ limited reviews do not always identify inaccurate wage data; the rural floor decreases wage index accuracy; and hold-harmless provisions in federal [...]

iqtsupport2018-11-29T06:00:57-05:00November 29, 2018|Medicare regulations|