Medicare

OIG: Medicare Advantage Plans May be Denying Access to Save Money

The Office of the Inspector General of the U.S. Department of Health and Human Services is concerned that Medicare Advantage plans may be denying their members access to services to save money and increase profits. According to the OIG, those Medicare Advantage plans overturn 75 percent of their own denials of service upon appeal and independent reviewers are overturning still more denials. In the OIG’s view, this high rate of service denials raises concerns that Medicare Advantage plans, which today serve more than 20 million seniors, are denying their members access to needed medical services so they can cut costs [...]

iqtsupport2018-10-02T06:00:41-04:00October 2, 2018|Medicare|

New Approach to Readmissions Program to Take Effect October 1

Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals. The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve. The readmissions performance of hospitals is then compared only to other hospitals within each peer group. As [...]

iqtsupport2018-10-01T06:00:29-04:00October 1, 2018|Medicare, Medicare regulations|

CMS Proposes Easing Regulatory Requirements

In a newly proposed rule, the Centers for Medicare & Medicaid Services proposes easing the regulatory burden on health care providers. The proposed regulation, which weighs in at 285 pages, covers a broad range of government regulation of health care providers and would, CMS projects, save hospitals more than $1 billion a year while cutting millions of hours of administrative work. Learn more about what CMS proposes by reading its fact sheet on the proposed regulation or going here to see the proposed regulation itself.

iqtsupport2018-09-24T06:00:42-04:00September 24, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations|

Medicare Joint Replacement Program Produces Savings

The first reporting period for Medicare’s Comprehensive Care for Joint Replacement Model found that participating providers cut costs for episodes of care by more than $900, or 3.3 percent. Most of the savings, the Centers for Medicare & Medicaid Services reports, were achieved by sending patients to less-expensive post-acute-care settings or by reducing patients’ length of stay in such facilities. CMS also found that the program’s mandatory participants, located in 67 metropolitan statistical areas, achieved these savings without compromising quality of care as measured by post-discharge emergency room visits, hospital readmissions, and deaths. Learn more about CJR’s early results in [...]

iqtsupport2018-09-14T06:00:50-04:00September 14, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicare|

MedPAC Meets

The Medicare Payment Advisory Commission met last week in Washington, D.C. to address a number of Medicare reimbursement-related issues. Among the subjects on MedPAC’s agenda were: a unified payment system for post-acute care long-term-care hospitals physician payments next steps in redesigning Medicare’s hospital quality and value programs While MedPAC’s policy and payment recommendations are not binding on Congress or the administration, its views are respected and influential and often become the basis for new public policy. Go here to see the policy briefs and presentations offered to help guide MedPAC commissioners’ discussions about these and other issues.

iqtsupport2018-09-13T06:00:56-04:00September 13, 2018|Medicare, Medicare post-acute care, MedPAC|

Ways and Means Praises CMS for Red Tape Efforts, Seeks More

Leaders of the House Ways and Means Committee have written to Centers for Medicare & Medicaid Services administrator Seema Verma to praise her agency’s work in eliminating Medicare red tape – but also asking her to “…take further steps to improve patient care by alleviating administrative and regulatory burdens for Medicare providers.” In three separate letters, committee chairman Kevin Brady (R-TX) and Health Subcommittee chairman Peter Roskam (R-IL) expressed their pleasure with CMS’s recent efforts but specified areas where they would like to see further action. For hospitals, they wrote that they seek further red-tape cutting in the areas of [...]

iqtsupport2018-09-11T06:00:49-04:00September 11, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare regulations|

Congress Asks MedPAC to Look at Hospital Consolidation

The House Energy and Commerce Committee has asked the Medicare Payment Advisory Commission to examine the impact of hospital consolidation on patients and federal health care spending. In a letter signed by Energy and Commerce Committee chairman Greg Walden (R-OR), Health Subcommittee chairman Michael Burgess (R-TX), and Oversight and Investigations Subcommittee chairman Gregg Harper (R-MS), the Energy and Commerce Committee states that We request the Medicare Payment Advisory Commission (MedPAC) conduct research examining questions regarding the market trend of hospital consolidation and the degree to which such consolidation increases cost to the Medicare program and beneficiaries, including the costs for [...]

iqtsupport2018-09-07T06:00:18-04:00September 7, 2018|hospitals, Medicare, MedPAC|

Hospitals Find Bundled Payment Savings Through Attention to Nursing Care

Hospitals participating in Medicare’s Comprehensive Care for Joint Replacement model and its Bundled Payments for Care Improvement program are finding the savings the program seeks in part through greater attention to the post-acute-care needs of their patients. As a new study has found: One principal strategy was to reduce SNF referrals, using risk-stratification tools, patient education, home care supports, and linkages with home health agencies to facilitate discharges to home. Another was to enhance integration with SNFs: fifteen hospitals or health systems in our sample had formed networks of preferred SNFs to exert influence over SNF quality and costs. Learn [...]

iqtsupport2018-09-06T06:00:22-04:00September 6, 2018|Medicare|

Next Generation ACO Nets Savings

Medicare’s Next Generation Accountable Care Organization model saved taxpayers $62 million in 2016, or 1.1 percent of the spending of the participating organizations, the Centers for Medicare & Medicaid Services has announced. The program also reduced hospitalizations 1.3 percent. In all, 18 organizations participated in the model program in 2016. Among them, four organizations accounted for more than half of the savings. In 2015, 45 organizations participated in the model and 51 are participating this year. Under the Next Generation ACO model, participants assume greater financial risk for their performance than under other Medicare models but also are eligible to [...]

iqtsupport2018-09-04T06:00:50-04:00September 4, 2018|Accountable Care Organization, ACO, Medicare|

HHS Seeks Feedback on Anti-Kickback Challenges

The Office of the Inspector General of the U.S. Department of Health and Human Services has issued a request for information from health care stakeholders on how the federal government might modify current safe-harbor and anti-kickback laws and regulations in ways that might promote the provision of better health care at lower costs. The RFI explains that The Office of Inspector General (OIG) seeks to identify ways in which it might modify or add new safe harbors to the anti-kickback statute and exceptions to the beneficiary inducements civil monetary penalty (CMP) definition of “remuneration” in order to foster arrangements that [...]

iqtsupport2018-08-28T14:45:40-04:00August 28, 2018|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|