Medicare area wage index

Federal Health Policy Update for October 24

The following is the latest health policy news from the federal government for October 18-24. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has issued new guidance outlining regulatory requirements for hospitals to report specific data on COVID-19, flu, and RSV. The new weekly electronic reporting requirements will apply to short-term acute-care hospitals, long-term-care hospitals, critical access hospitals, Indian Health Service hospitals, children’s hospitals, and cancer hospitals, with other types of hospitals – psychiatric hospitals and distinct part units and inpatient rehabilitation hospitals and distinct part units – subject [...]

joe2024-10-24T14:58:32-04:00October 24, 2024|Affordable Care Act, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

MedPAC Meets

The government agency that advises Congress on Medicare payment matters met publicly in Washington, D.C. last week. During the virtual meeting, members of the Medicare Payment Advisory Commission discussed: reforming Medicare’s wage index system addressing the high prices of drugs covered under Medicare Part B a prototype design for a post-acute care prospective payment system favorable selection and future directions for Medicare Advantage payment policy aligning fee-for-service payment rates across ambulatory care settings MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding on either Congress or the administration, MedPAC is [...]

iqtsupport2023-03-09T13:00:37-05:00March 9, 2023|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, post-acute care|

MedPAC Meets

The Medicare Payment Advisory Commission held public meetings on September 1 and 2. Among the subjects discussed during the meeting were: Reforming Medicare’s wage index system – “the commission remains concerned about Medicare’s current wage index policies, including the system’s inaccuracy, the circularity of hospital-reported data, the large volume of permitted exceptions, and administrative complexity and MedPAC commissioners discussed an alternative wage index methodology.” Context for Medicare payment policy – an annual discussion. Standardizing benefits in Medicare Advantage plans – cost sharing for Part A and Part B services Medicare Advantage encounter data – “MedPAC has been concerned about the [...]

iqtsupport2022-09-08T06:00:28-04:00September 8, 2022|Medicare reimbursement policy, MedPAC|

CMS Finalizes FY 2021 Payments to Hospitals

Medicare has announced how it will pay hospitals for inpatient care in FY 2021 with publication of its annual inpatient prospective payment system regulation last week. Among the changes announced by the Centers for Medicare & Medicaid Services: A 2.9 percent increase in fee-for-service inpatient rates. A compromise on its proposal to require hospitals to report their payer-specific negotiated rates with Medicare Advantage plans. Changes in how Medicare will calculate Medicare disproportionate share (Medicare DSH) uncompensated care payments. A much smaller cut than originally proposed in the pool of funds for Medicare DSH uncompensated care payments. Minor adjustments in the [...]

iqtsupport2020-09-09T06:00:15-04:00September 9, 2020|hospitals, Medicaid regulations, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

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 Posts Proposed FY 2020 Inpatient Regulation

Medicare would change its wage index system, raise inpatient fees, increase funding for Medicare disproportionate share hospital payments (Medicare DSH), enhance payments for new technologies, and make minor modifications in its hospital readmissions reduction, value-based purchasing, and hospital-acquired condition program if a proposed regulation published this week is ultimately adopted. The Centers for Medicare & Medicaid Services has published its proposed FY 2020 Medicare inpatient prospective payment system regulation: its plan for paying acute-care hospitals for Medicare-covered inpatient services in FY 2020. The 1800-page regulation calls for major changes in Medicare’s wage index system – changes CMS says would “…address [...]

iqtsupport2019-04-25T06:00:11-04:00April 25, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

HHS Chief Derides Medicare Wage Index System

U.S. Department of Health and Human Services Secretary Alex Azar criticized the current Medicare area wage index system during a hearing of the Senate Finance Committee last week. Reminding senators that he told them last year that they need to revise the system and warning that HHS’s ability to change it is limited without legislation, Azar referred to the system as an “absurdity” as individual senators pointed out what they view to be inequities in the system that hurt hospitals in their own states. Medicare’s area wage index system adjusts Medicare payments to hospitals based on geographic differences in the [...]

iqtsupport2019-03-21T06:00:01-04:00March 21, 2019|Medicare, Medicare regulations|

OIG Cites “Vulnerabilities” in Medicare Wage Index System

The Office of the Inspector General of the U.S. Department of Health and Human Services has “…observed significant vulnerabilities in the [Medicare area] wage index system…” As a result of these vulnerabilities, Medicare has overpaid 272 hospitals by more than $140 million over the past 13 years. The vulnerabilities the OIG identified that contributed to these overpayments are: absent misrepresentation or falsification, CMS lacks the authority to penalize hospitals that submit inaccurate or incomplete wage data; Medicare Administrative Contractors’ limited reviews do not always identify inaccurate wage data; the rural floor decreases wage index accuracy; and hold-harmless provisions in federal [...]

iqtsupport2018-11-29T06:00:57-05:00November 29, 2018|Medicare regulations|