Medicare reimbursement policy

House to Consider Extending Medicare Sequester Delay

The moratorium on the two percent sequestration of Medicare payments could be extended under a bill the House may consider this week. If adopted, the bill would extend the sequester delay for nine months, providing financial relief that many health care providers seek as they continue to deal with the financial challenges posed by COVID-19. The sequester delay was implemented early in the pandemic as a means of providing additional Medicare revenue to hospitals and other health care providers at a time when many people were delaying seeking medical attention out of fear of contracting COVID-19. Without action by Congress, [...]

iqtsupport2021-03-18T06:00:49-04:00March 18, 2021|Medicare, Medicare cuts, Medicare reimbursement policy|

Analysts Look at Medicare Wage System

The Congressional Research Service has published a new report on the Medicare hospital wage index system. The agency undertook its analysis because Some Members of Congress, hospitals, and independent analysts have expressed interest in the differences in Medicare hospital payments by geographic area, based on the wage index. Some of these stakeholders have recommended changes to the wage index to more accurately reflect labor market forces faced by hospitals. Although some modifications to the wage index have been implemented, there is no consensus about systematic reforms. In the report the CRS describes how the geographic wage system works and what [...]

iqtsupport2021-03-09T06:00:24-05:00March 9, 2021|Medicare, Medicare reimbursement policy|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. recently to discuss various Medicare payment issues. Among the issues discussed at MedPAC’s January meeting were: hospital inpatient and outpatient payments physician and health professionals payments the possible expansion of the post-acute transfer policy to hospice ambulatory surgical center, outpatient dialysis, and hospice payments Medicare payments for skilled nursing facilities, long-term hospitals, inpatient rehabilitation facilities, and home health services the Center for Medicare and Medicaid Innovation’s development and implementation of alternative payment models the future of telehealth after the COVID-19 public health emergency ends a status report on the Medicare Part [...]

iqtsupport2021-01-25T06:00:58-05:00January 25, 2021|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. MedPAC’s proposed Medicare 2021 payment recommendations dominated the December agenda, including: hospital inpatient and outpatient payments ambulatory surgical center payments physician and health professional payments hospice payments home health care payments inpatient rehabilitation facility payments long-term care hospital payments In addition, MedPAC discussed Medicare’s policy for transfers between post-acute-care facilities and hospice and received a staff update on the Medicare Advantage program. MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding [...]

iqtsupport2020-12-10T06:00:36-05:00December 10, 2020|Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

MedPAC Meets

Earlier this week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. Among the issues on MedPAC’s November agenda were: expansion of telehealth in Medicare report on Medicare beneficiaries’ access to care in rural areas effects of pharmaceutical rebates on Part D’s risk adjustment improving competition among Medicare Part D’s benchmark plans separately payable drugs in the hospital outpatient prospective payment system Medicare Advantage payment and access for enrollees with end-stage renal disease MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are [...]

iqtsupport2020-11-12T06:00:40-05:00November 12, 2020|Medicare, Medicare regulations, Medicare reimbursement policy|

Most Hospitals Fined by Medicare Over Readmissions

More than 80 percent of all hospitals subject to Medicare’s hospital readmissions reduction program, and half of all of hospitals in the country, will be penalized in FY 2021 under that program because they have what Medicare considers to be too many avoidable readmissions. In all, 2556 of the 3080 hospitals subject to the program will be penalized. More than 600 will see their inpatient payments cut one percent as a result and the average cut will be 0.69 percent. The penalties are based on hospital performance with patients experiencing congestive heart failure, heart attacks, chronic obstructive pulmonary disease, coronary [...]

iqtsupport2020-11-06T06:00:25-05:00November 6, 2020|Medicare regulations, Medicare reimbursement policy|

Feds Penalizing Wrong Hospitals for Readmissions, Study Finds

Medicare’s hospital readmissions reduction program often penalizes the wrong hospitals for excessive readmissions. Or so concludes a new study published in the journal JAMA Cardiology. According to the study, …the percentage of hospitals that were incorrectly penalized was 10.1% for acute myocardial infarction, 10.9% for heart failure, and 12.3 percent for pneumonia. The study also found that the readmissions reduction program is failing to penalize some hospitals that do deserve penalties based on the program’s standards, writing that …in fiscal year 2019, the percentage of hospitals that should have been penalized by the program, but were not, was 20.9% for [...]

iqtsupport2020-10-20T06:00:30-04:00October 20, 2020|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: the skilled nursing facility value-based payment system future research directions in hospice payments Medicare Advantage benchmark policy indirect medical education: current Medicare policy, concerns, and principles for revising the evolution of Medicare’s advanced alternative payment models vertical integration and Medicare payment policy MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in [...]

iqtsupport2020-10-09T06:00:26-04:00October 9, 2020|Alternative payment models, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Private Insurer Payments Far Exceed Medicare Payments, Study Finds

“…employers and private insurers … paid 247 percent of what Medicare would have paid for the same services at the same facilities,” according to a new study by the Rand Corporation, which also notes that “This difference increased from 224 percent of Medicare in 2016 and 230 percent in 2017.” The study also found that: From 2016 to 2018, the overall relative price for hospitals (including inpatient and outpatient care) increased from 224 to 247 percent, a compounded annual rate of increase of 5.1 percent. Some states (Arkansas, Michigan, Rhode Island) had relative prices under 200 percent of Medicare; others [...]

iqtsupport2020-09-23T13:39:09-04:00September 23, 2020|Medicare, Medicare reimbursement policy|

MedPAC Talks Telehealth

Expanded telehealth is here to stay, members of the Medicare Payment Advisory Commission agreed at their September public meeting. What they do not yet know is in what form. Among the issues that need to be addressed in any post-COVID-19 expansion of Medicare-covered telehealth services are: Whether affording access to telehealth services would exacerbate the digital divide and leave some Medicare beneficiaries with less access to care than others. Whether audio-only coverage, temporarily permitted during the pandemic, should be continued. Whether greater use of telehealth might foster greater use of low-value services. Whether use of non-HIPAA-compliant video technology should continue [...]

iqtsupport2020-09-11T06:00:46-04:00September 11, 2020|Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|