Medicare

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|

Feds Delay Stark Rule, Anti-Kickback Update

An update of regulations that limit the ability of doctors to refer patients for care to sources in which those doctors have a financial interest will wait as long as another year, according to the Centers for Medicare & Medicaid Services. CMS had previously proposed regulations updating current guidelines, essentially easing them, but provider comment was so great – often, saying that the easing of the guidelines did not go far enough – that the agency decided to step back and review the situation. In a public inspection version of a notice to be published in the Federal Register, CMS [...]

iqtsupport2020-08-29T06:00:59-04:00August 29, 2020|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|

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|

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|

Loan Repayment Looms for Hospitals

Unless Congress intervenes, hospitals will soon begin repaying massive federal loans they received to help them cope with the COVID-19 public health emergency. The loans, authorized by the federal CARES Act, were made through the Accelerated and Advance Loan Program, and in all, Medicare made nearly $100 billion in such loans to providers. Under the legislation, Medicare was to begin recouping the loans 120 days after hospitals received them, with recoupment coming by Medicare ceasing to pay hospitals’ Medicare claims until the full amount of the loan was repaid. Now the loans are coming due but hospitals are saying they [...]

iqtsupport2020-08-05T13:00:56-04:00August 5, 2020|Medicare|

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|

Coronavirus Update: March 31, 2020

Coronavirus Update: March 31, 2020 Yesterday the federal Centers for Medicare & Medicaid Services (CMS) published a major update of Medicare and Medicaid regulations that included blanket waivers of a large number of Medicare and Medicaid regulations and requirements. The following is a summary of the major aspects of this new regulation. New Policies and Waivers From Medicare and Medicaid Regulations and Requirements CMS has introduced dozens of changes that involve waivers from current regulations and requirements. A comprehensive, 26-page CMS document describing these changes can be found here and below are the highlights organized into four broad categories: increasing [...]

iqtsupport2020-03-31T20:24:34-04:00March 31, 2020|Coronavirus, COVID-19, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Telehealth|

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|