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|

CBO Targets Health Care in Options for Reducing Deficit

Every year the Congressional Budget Office publishes a menu of options for reducing federal spending and the federal budget deficit. As in the past, this year’s compendium includes a number of options to reduce federal health care spending and raises federal revenue through health care initiatives. The cost-cutting options include: establish caps on federal spending for Medicaid limit states’ taxes on health care providers reduce federal Medicaid matching rates change the cost-sharing rules for Medicare and restrict Medigap insurance raise the age of eligibility for Medicare to 67 reduce Medicare’s coverage of bad debt consolidate and reduce federal payments for [...]

iqtsupport2018-12-18T09:34:31-05:00December 18, 2018|deficit reduction, Medicaid, Medicare, Medicare bad debt reimbursement, Medicare cuts, Medicare reimbursement policy|

MedPAC Mulls Billing Change for Nurse Practitioners, Physician Assistants

Medicare would permit nurse practitioners and physician assistants to bill directly for their services under a proposal being considered by the Medicare Payment Advisory Commission. Currently such services are billed as “incident to” physician services, but according to a report in Becker’s Hospital Review, MedPAC staff told commissioners there are problems with “incident to” billing because it “obscures policymakers’ knowledge of who is providing care for beneficiaries,” “inhibits accurate valuation of fee schedule services,” and “increases Medicare beneficiary spending.” Staff also said that physician assistants and nurse practitioners increasingly practice outside of primary care. MedPAC is an independent congressional agency [...]

iqtsupport2018-12-13T06:00:59-05:00December 13, 2018|Medicare, Medicare reimbursement policy, MedPAC|

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|

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 December agenda were: Medicare payments for physician and other health professionals services payments for ambulatory surgical centers payments for hospital inpatient and outpatient care Medicare’s hospital quality incentive program payments for skilled nursing facilities payments for long-term care hospitals payments for inpatient rehabilitation facilities payments for outpatient dialysis services payments for hospice care payments for home health services the Medicare Advantage program MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. [...]

iqtsupport2018-12-11T06:00:45-05:00December 11, 2018|hospitals, Medicare, Medicare reimbursement policy, MedPAC|

CMS Releases New Home Health Regulation for 2019

A new regulation will bring changes in how Medicare pays for and regulates home health services in 2019. Included in the regulation released last week are: A 2.2 percent increase in home health payments. Creation of remote patient monitoring benefit for home health patients. Creation of a home infusion benefit. Removal of some measures from the home health quality reporting program. Changes in the home health value-based purchasing model. For a complete look at the changes coming to how Medicare will treat home health services in 2019, go here to see a CMS fact sheet on the new regulation and [...]

iqtsupport2018-11-07T06:00:06-05:00November 7, 2018|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 November agenda were: MedPAC’s mandated report on long-term care hospitals patient functional assessment data used in Medicare payment and quality measurement modifying advanced alternative payment model (A-APM) payments modifying the Medicare-dependent hospital program promoting greater Medicare-Medicaid integration in dual-eligible special-needs plans the Medicare Advantage quality bonus program Medicare Advantage encounter data 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 [...]

iqtsupport2018-11-06T06:00:50-05:00November 6, 2018|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

New Home Health Reg Brings Changes

A new home health care regulation finalized by the Centers for Medicare & Medicaid Services brings major changes in how Medicare will pay for home health services in the future. In addition to updating Medicare payment rates, the new rule also: introduces a new home health payment system called the Patient-Driven Groupings Model that de-emphasizes the volume of care provided; authorizes Medicare payments for remote patient monitoring; adds a new home infusion therapy benefit; and reduces the amount of quality data home health providers must report. To learn more about the new regulation, which takes effect on January 1, 2019, [...]

iqtsupport2018-11-02T06:00:49-04:00November 2, 2018|Centers for Medicare & Medicaid Services, Medicare regulations, Medicare reimbursement policy|

CMS Proposes Increasing Use of Telehealth by Medicare Advantage Plans

Medicare Advantage plans would be authorized to make greater use of telehealth services under a new regulation to be proposed by the Centers for Medicare & Medicaid Services. The proposal, part of a broader regulation addressing a variety of Medicare programs, would authorize wider use of telehealth services in caring for Medicare Advantage enrollees while improving provider payments for those services. According to a CMS fact sheet about the proposed regulation, The Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” not otherwise available in Original Medicare to enrollees starting in plan year 2020. Under this [...]

iqtsupport2018-10-31T06:00:06-04:00October 31, 2018|Medicare, Medicare regulations, Medicare reimbursement policy|