Medicare

New ACO Incentive: Exemption From 3-Day Stay SNF Requirement

In an effort to encourage more Medicare accountable care organizations to assume financial risk for the care of their patients, the Centers for Medicare & Medicaid Services is extending its exemption from the three-day inpatient stay requirement before Medicare ACOs can discharge their patients to skilled nursing facilities to ACOs participating in selected ACO model programs that involve two-sided risk under preliminary prospective assignment with retrospective reconciliation. This move expands the waiver from the three-day SNF requirement that ACOs that assume greater financial risk already receive. Details about the new policy, including the ACO models that qualify for this exemption [...]

iqtsupport2019-01-17T06:00:00-05:00January 17, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

Readmissions Reduction Program Results Overstated?

A new study suggests that the encouraging results of Medicare’s hospital readmissions reduction program may not actually be as encouraging as people thought. According to a new study published in the journal Health Affairs, data on reduced readmissions may be more the result of changes in hospital coding practices than improved quality performance by hospitals. The report suggests that new industry standards for reporting were implemented at roughly the same time Medicare launched the value-based purchasing program and may account for most or even all of the reported improved performance by hospitals. Learn more from the Health Affairs study “Decreases [...]

iqtsupport2019-01-14T06:00:42-05:00January 14, 2019|Medicare, 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|

Administration Seeks Industry Guidance on Rollback of Anti-Kickback Laws

Characterizing its objective as a “regulatory sprint to coordinated care,” the Department of Health and Human Services’ Office of the Inspector General this summer asked stakeholders for their input on how it might ease federal anti-kickback laws in ways that promote better coordination of care and cooperation between different types of caregivers while not encouraging fraud that costs consumers and taxpayers. At the heart of this effort are laws that limit the ability of doctors and hospitals to work together. Hospitals, for example, currently have limited tools with which to influence the behavior of doctors serving Medicare and Medicaid patients [...]

iqtsupport2018-11-27T11:00:02-05:00November 27, 2018|Medicare|

CMS to Congress: You’re the Impediment to Greater Use of Telehealth

The primary obstacle to Medicare making greater use of telehealth is current laws, the Centers for Medicare & Medicaid Services has told Congress in a new report. The report, mandated by the 21st Century Cures Act, outlines the extent of telehealth utilization today, describes its benefits, and suggests potential new and expanded uses for telehelath, but it also notes that Current restrictions on eligible telehealth originating sites appear to be the greatest barrier to preventing the expansion of Medicare telehealth services. The two most significant Medicare restrictions are: 1) requiring the originating site to be located in certain types of [...]

iqtsupport2018-11-20T06:00:23-05:00November 20, 2018|Medicare, Telehealth|

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries. As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City, These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too. If seniors do end up going to [...]

iqtsupport2018-11-19T06:00:47-05:00November 19, 2018|Medicare|

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|