Uncategorized

Earmarks Expected to Return

After a ten-year absence, congressional earmarks appear to be on their way back. Earmarks – special budget items chosen by members of Congress specifically for their districts – were banned in 2011 but now, members of the House have voted to revive them, citing the oft-used rationale that members of Congress are more qualified to choose projects for their districts than federal bureaucrats. In addition, it is widely thought that earmarks can help build bipartisan support for challenging legislation. Amid concern about the possibility of increasing federal spending at a time of rising deficits, the Senate still has not agreed [...]

admin2021-03-23T06:00:28+00:00March 23, 2021|Uncategorized|

Bundled Payments Produce Savings Among Privately Insured

Bundled payments for a limited number of surgical procedures produced a savings of 10.7 percent among privately insured patients according to a study by the RAND Corporation. For the study, participants working for self-insured employers who received three types of surgery – total knee and hip replacement, spinal fusion, and bariatric weight-loss procedures – were offered the opportunity to have those procedures without cost-sharing in exchange for undergoing surgery by specific providers that agreed to accept a bundled payment for the procedure and 30 days of post-surgical care. The result was a savings of 10.7 percent in costs, 85 percent [...]

admin2021-03-04T06:00:43+00:00March 4, 2021|Uncategorized|

The New Administration’s Health Care Team

Becker’s Hospital Review has published a list of 35 officials who are currently part of the Biden administration’s health care team. Some are staff, some are appointments awaiting Senate confirmation, and some are serving on an interim basis until permanent replacements can be chosen and/or confirmed. The list includes links to information about each individual. See the list here.

admin2021-02-09T06:00:09+00:00February 9, 2021|Uncategorized|

Coronavirus Update for Monday, February 1

The following is the latest COVID-19 information from the federal government as of 2:30 p.m. on Monday, February 1. Centers for Medicare & Medicaid Services CMS has compiled resources and materials to help providers share important and relevant information about the COVID-19 vaccine with the people they serve. These resources include: CMS’s COVID-19 Partner Resources Page the HHS COVID Education Campaign page the CDC Resources for Health Care Providers Page CMS’s COVID-19 Provider Toolkit CMS’s FAQ on Medicare fee-for-service billing Resources for Medicare beneficiaries about coverage for COVID-19 vaccines CMS has updated its list of hospitals approved to participate in [...]

admin2021-02-02T06:00:00+00:00February 2, 2021|Coronavirus, COVID-19, Uncategorized|

Insurers Owe Customers Billions

Low medical loss ratios will compel insurers to return nearly $2.5 billion to their customers for the 2019 reporting year. Under federal law, individual and small group insurers must spend 80 percent of their premium revenue on health care services and large group insures must spend 85 percent. If they fail to do so they must return the difference to their enrollees, whether individuals, employers, or a combination of the two. In all, insurers owe nearly $2.5 billion – the most ever in a single year – to more than 11 million customers. Rebates can be paid as premium credit [...]

admin2020-11-30T06:00:49+00:00November 30, 2020|Uncategorized|

Number of Uninsured Children Rising

The number of uninsured children in the U.S. is rising. Since 2016, the number of uninsured children has risen by approximately 726,000 as the uninsured rate among children rose from 4.7 percent to 5.7 percent in 2019. An increase of 320,000 children between 2018 and 2019 was the largest such increase in more than a decade. Texas accounts for one-third of the four-year increase, or about 243,000 newly uninsured children, with Florida second with 55,000 newly uninsured children. Learn more about the increase in the number of uninsured children in recent years and why it occurred in the report “Children’s [...]

admin2020-10-19T06:00:16+00:00October 19, 2020|Uncategorized|

Coronavirus Update for Tuesday, October 6

The Department of Health and Human Services is now providing extensive information about its planned Phase 3 distribution of Provider Relief Funds. Background Last Thursday HHS announced the planned distribution of $20 billion in new funding for providers on the front lines of the COVID-19 pandemic. Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and increased expenses experienced due to COVID-19. Previously ineligible providers, such as those that began practicing in 2020, will also be invited to apply, and an expanded [...]

admin2020-10-07T06:00:54+00:00October 7, 2020|Uncategorized|

Coronavirus Update for Thursday, June 4

Coronavirus update for Thursday, June 4 as of 2:30 p.m. Centers for Medicare & Medicaid Services CMS has published a compendium of Medicare physician fee schedule changes implemented in recent months in response to the COVID-19 crisis. CMS has posted a table that describes COVID-19 adjustments announced yesterday for CMMI model programs. CMS announced that the Nursing Home Compare web site now provides data on COVID-19 cases and deaths in individual nursing homes. Accompanying this announcement is publication of an FAQ on this nursing home data and a memo to state Medicaid programs about the data. Department of Health [...]

admin2020-06-05T06:00:43+00:00June 5, 2020|Uncategorized|

Coronavirus Update for May 28, 2020

Coronavirus update for Thursday, May 28 as of 2:30 p.m. Centers for Medicare & Medicaid Services CMS has updated its COVID-19 FAQs on Medicare fee-for-service billing with additional or revised answers to the following sections: Expansion of Virtual Communication Services for FQHCs/RHCs – questions 11-23 Medicare Telehealth (please note that these FAQs do not include flexibilities that might be exercised under the CARES act) – questions 23-33 General Billing Requirements – questions 2 and 3 Diagnosis Coding under International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) – question 1 Chronic Care Management Services – question 1 Outpatient Therapy Services [...]

admin2020-05-29T06:00:11+00:00May 29, 2020|Coronavirus, COVID-19, Uncategorized|

Coronavirus Update for May 15, 2020

Coronavirus update for Friday, May 15 as of 2:30 p.m. Centers for Medicare & Medicaid Services CMS released a bulletin that gives guidance to states on how to temporarily modify provider payment methodologies and capitation rates under their Medicaid managed care contracts to address the impact of the COVID-19 emergency while preserving systems of care and access to services for Medicaid beneficiaries. See CMS’s announcement of the bulletin here and find the bulletin itself here. CMS updated its COVID-19 FAQ on Medicare fee-for-serving billing with new information about accountable care organizations that terminate their Shared Savings Program agreement (p. 40). [...]

admin2020-05-18T06:00:51+00:00May 18, 2020|Coronavirus, COVID-19, Uncategorized|