Medicare reimbursement policy

OIG Cites Medicare, Medicaid Among Top Unimplemented Recommendations

CMS has failed to implement many of the policy changes recommended to it by HHS’s Office of the Inspector General, according to a new OIG report. Every year the Department of Health and Human Services’ OIG offers recommendations for policy changes designed to reduce fraud, waste, and abuse in HHS programs. This week, the OIG published “OIG’s Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs.” Among the top 25 unimplemented recommendations to the Centers for Medicare & Medicaid Services are 14 involving Medicare and Medicaid. Its top 10 unimplemented Medicare recommendations are: CMS should take [...]

iqtsupport2020-08-11T10:33:28-04:00August 11, 2020|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare reimbursement policy|

Feds Propose Changing Medicare DSH Calculation

Medicare DSH payments would reflect hospitals’ Medicare Advantage inpatient days under a new regulation proposed by the Centers for Medicare & Medicaid Services. Under the newly proposed rule, the formula for calculating Medicare disproportionate share payments would incorporate hospitals’ Medicare Advantage inpatient days and not just their fee-for-service inpatient days. Medicare DSH payments are made to hospitals that serve especially high proportions of low-income and uninsured patients and are intended to help them with the cost of providing those services. Go here to see the proposed regulation.

iqtsupport2020-08-07T06:00:49-04:00August 7, 2020|Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

CMS Proposes New Medicare Payments for 2021

Medicare will change its provider payments for two types of Medicare-covered services in 2021 and has proposed changes in payments for three other Medicare-covered services in a flurry of activity over the past week. Last week the Centers for Medicare & Medicaid Services finalized new 2021 Medicare payment rates for: skilled nursing facilities hospice services inpatient psychiatric facilities In addition, this week CMS proposed new 2021 Medicare rates for: physician services outpatient and ambulatory surgical services The proposed changes in Medicare provider payments for physician services and outpatient and ambulatory surgical services are subject to a public comment period before [...]

iqtsupport2020-08-06T06:00:39-04:00August 6, 2020|Medicare, Medicare regulations, Medicare reimbursement policy, post-acute care|

MedPAC Reports to Congress

MedPAC has submitted its annual report to Congress. The congressionally mandated report, titled Report to Congress: Medicare and the Health Care Delivery System, consists of seven chapters: Realizing the promise of value-based payment in Medicare: an agenda for change. Challenges in maintaining and increasing savings from accountable care organizations (ACOs). Replacing the Medicare Advantage quality bonus program. Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees. Realigning incentives in Medicare Part D. Separately payable drugs in the hospital outpatient prospective payment system (OPPS). Improving Medicare’s end-state renal disease (ESRD) prospective payment [...]

iqtsupport2020-06-22T06:00:10-04:00June 22, 2020|Accountable Care Organization, ACO, Medicare, Medicare reimbursement policy, MedPAC|

MedPAC Offers 2021 Medicare Rate Recommendations

MedPAC has recommended to Congress changes in Medicare payment rates in the coming year. In its annual report to Congress, the Medicare Payment Advisory Commission recommended the following rate changes: acute-care hospitals – a two percent rate increase and a suggestion that the difference between this two percent increase and the payment increase specified by law be used to increase the rewards hospitals may earn under Medicare’s hospital value incentive program. As a result, the value incentive program would offer a possible 0.8 percent in bonus payments, and with the recommended elimination of the 0.5 percent penalty for which hospitals [...]

iqtsupport2020-03-26T11:48:02-04:00March 26, 2020|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy, MedPAC|

CMS Authorizes Waiving of Some Medicare Coronavirus Fees

Medicare Advantage organizations, Medicare Part D plans, and Medicare-Medicaid managed care plans have been directed by the Centers for Medicare & Medicaid Services to waive cost-sharing for testing and treatment of the novel coronavirus. This news was transmitted to those payers in a March 10 letter from CMS. The directive also authorizes Medicare Advantage plans to waive coronavirus-related telehealth fees and authorizes Part D plans to relax refill-too-soon limits, provide maximum expended day supplies of prescription drugs, reimburse enrollees for prescription drugs obtained from out-of-network pharmacies, ease prior authorization limits on drugs prescribed to treat patients with the disease, and [...]

iqtsupport2020-03-12T06:00:10-04:00March 12, 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 March agenda were: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Realigning incentives in Medicare Part D Redesigning the Medicare Advantage quality bonus program Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees Improving Medicare’s end-stage renal disease prospective payment system Separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency that advises [...]

iqtsupport2020-03-09T09:40:54-04:00March 9, 2020|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Number of Medicare-Dependent Hospitals Declines

The number of Medicare-dependent hospitals in the U.S. fell 28 percent between 2011 and 2017, the U.S. Government Accountability Office reports. Medicare-dependent hospitals receive additional payments from Medicare if at least 60 percent of their discharges or inpatient days are associated with Medicare patients, if they have 100 or fewer beds, and if their historic costs in one of three base years are greater than what they would have been paid through Medicare’s inpatient prospective payment system. The Medicare-dependent program was created in 1989 to protect vulnerable small, mostly rural hospitals, and in any given year not all eligible hospitals [...]

iqtsupport2020-03-03T06:00:53-05:00March 3, 2020|Medicare, Medicare reimbursement policy|

Hundreds of Hospitals Penalized for Medical Mistakes

786 hospitals will see their Medicare payments slashed one percent for a year because of their performance under Medicare’s hospital-acquired conditions reduction program. That program penalizes the 25 percent of hospitals with the highest rate of patient safety problems, such as infections and injuries. Among the more interesting aspects of this year’s program results: Among those being penalized are seven of the 21 hospitals on the S. News “best hospitals” list. Three hospitals also on that list have never been penalized. 145 hospitals will be penalized for the first time. 16 hospitals that have been penalized every year since the [...]

iqtsupport2020-02-05T06:00:24-05:00February 5, 2020|Medicare, Medicare regulations, 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 January agenda were: The Medicare prescription drug program (Part D): status report and options for restructuring Redesigning the Medicare Advantage quality program: initial modeling of a value incentive program Hospital inpatient and outpatient payments Physician payments Outpatient dialysis payments Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments Hospice and ambulatory surgery center payments The 340B program ACO beneficiary assignment MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. [...]

iqtsupport2020-01-22T06:00:06-05:00January 22, 2020|Accountable Care Organization, ACO, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|