Medicare reimbursement policy

Improper Medicare Payments Down in FY 2019

The amount of improper Medicare payments made by the federal government fell $7 billion in federal fiscal year 2019, the Centers for Medicare & Medicaid Services reports. FY 2019 marked the third consecutive year that improper fee-for-service payments have fallen.  In FY 2018, improper payments accounted for 8.12 percent of Medicare fee-for-service spending but in FY 2019 that portion fell to 7.25 percent.  In FY 2019, CMS estimates that it made $28.9 billion in improper fee-for-service payments. $5.32 billion of the $7 billion reduction came through corrective actions in Medicare home health payments.  Other Medicare Part B services accounted for [...]

2019-11-19T14:00:06-05:00November 19, 2019|Medicare, Medicare reimbursement policy|

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 November agenda were: congressional request on health care provider consolidation increasing the supply of primary care physicians redesigning the Medicare Advantage quality bonus program reforming the benchmarks in the Medicare Advantage payment system considerations for plans serving low-income beneficiaries in the restructuring of Medicare Part D post-acute care spending under the Medicare Shared Savings Program MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on [...]

Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C. During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health. Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on [...]

More Hospitals Gain Than Lose in FY 2020 Value-Based Purchasing Program

Medicare’s value-based purchasing program will reward more hospitals than it will penalize in FY 2020 through its value-based purchasing program. The program, in which 2700 hospitals are scored in four domains – clinical outcomes, safety, person and community engagement, and efficiency and cost reduction – will distribute $1.9 billion in bonus payments to 1500 hospitals. Bonus payment average 0.6 percent, with a high of 2.93 percent.  Penalties average -0.39 percent, with a high of -1.72 percent. Overall, rural hospitals performed better in the safety, person and community engagement, and efficiency and cost reduction categories and had a higher average score [...]

2019-10-30T15:15:04-04:00October 30, 2019|hospitals, Medicare, Medicare reimbursement policy|

Hospitals Advocate Losing Chargemaster

Hospitals would no longer need to post their chargemaster prices under a new approach to Medicare payments being advocated by a new hospital lobbying group. The small group, calling itself the Chargemaster Alternatives for Medicare Payment Alliance, wants Medicare to eliminate payment formulas based on chargemaster prices and base them instead on actual costs.  Acting in response to a new proposal that hospitals be required to post their chargemaster prices, the group argues that chargemaster prices are irrelevant for all but a few consumers. Learn more about the group, its members, and its argument for ending use of chargemaster prices [...]

2019-10-28T06:00:54-04:00October 28, 2019|Medicare, Medicare reimbursement policy|

Court Upholds Delay of Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled. A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change.  The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it [...]

Most Hospitals Hit With Medicare Readmissions Penalties

Nearly 2600 hospitals will be penalized by Medicare in FY 2020 for excessive patient readmissions under Medicare’s hospital readmissions reduction program, according to the Centers for Medicare & Medicaid Services. In all, 83 percent of hospitals covered by the program will be penalized, forfeiting up to three percent of their Medicare payments with an average penalty of 0.71 percent of those payments.  The cumulative penalties for these hospitals will amount to $563 million in FY 2020. In all, 1177 hospitals will be penalized more than they were last year and 1148 will be penalized less.  56 hospitals will be assessed [...]

2019-10-08T06:00:52-04:00October 8, 2019|Medicare, Medicare reimbursement policy|

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: restructuring Medicare Part D improving Medicare payment for low-volume and isolated outpatient dialysis facilities updates to the methods used to assess the adequacy of Medicare’s payments for physicians and other health professionals population-based outcome measures:  avoidable hospitalizations and emergency department visits aligning benefits and cost-sharing under a unified payment system for post-acute care policy options to modify the hospice aggregate cap MedPAC is an independent congressional agency that advises Congress on issues involving the [...]

Court Halts Medicare Site-Neutral Payment Changes

The Centers for Medicare & Medicaid Services did not have the authority to implement the site-neutral payment system for Medicare-covered outpatient services that it introduced last year, a federal court has concluded. According to the court, CMS exceeded its authority because it …was not authorized to ignore the statutory process for setting payment rates in the Outpatient Prospective Payment System and to lower payment rates only for certain services provided by certain providers. In general, hospitals oppose the movement toward site-neutral payments and independent physician groups support it. The court did not order CMS to reimburse affected physician practices for [...]

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 September agenda were: context for Medicare payment policy the effects of Medicare Advantage “spillover” on Medicare fee-for-service spending and coding evaluation of the hospital readmissions reduction program examining the effects of competitive bidding for diabetes testing supplies and improving payment policies for DMEPOS products excluded from competitive bidding a value incentive program for post-acute-care providers Medicare indirect medical education (IME) policy, concerns, and considerations for revising MedPAC is an independent congressional agency that advises Congress on issues [...]

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