Medicare

Primary Care Accounts for Little Medicare Spending

Spending for primary care services accounts for only about two percent of Medicare fee-for-service spending, a new study has found. Even when the concept of primary care is expanded to include services provided by nurse practitioners, physician assistants, geriatricians, and gynecologists, all of whom bill for primary care services, that figure rises only to 4.88 percent. The proportion of primary care spending falls as Medicare beneficiaries age, a reflection of their greater consumption of specialist, hospital, and surgical care as they get older. Primary care spending was even lower among Medicare-eligible African-American, Native American, Medicaid-eligible seniors, and individuals with chronic [...]

iqtsupport2019-04-24T06:00:20-04:00April 24, 2019|Medicare|

A New Trend: Tying Insurance Payments to Medicare Rates?

There may be a growing movement to tie some hospital payments directly to Medicare rates. Montana started doing it two years ago, linking payments for hospital services provided to state employees to Medicare rates. Oregon will start a similar program this fall. And now, North Carolina is laying plans for a similar approach while Delaware is considering doing so. Montana is paying an average of 234 percent of Medicare hospital rates. Oregon will pay 200 percent of Medicare rates. North Carolina is talking about paying Medicare rates plus 82 percent, with extra money for rural hospitals. Such an approach could [...]

iqtsupport2019-03-25T06:00:16-04:00March 25, 2019|Uncategorized|

OIG: Medicare Errs in Paying for Some Skilled Nursing Care

Medicare is erroneously paying for skilled nursing facility care for beneficiaries who did not spend three nights in an acute-care hospital, the U.S. Department of Health and Human Services’ Office of the Inspector General has concluded. Based on a limited sampling, the OIG estimates that Medicare spent $84 million on such ineligible services from 2013 through 2015. A new report from the OIG explains that We attribute the improper payments to the absence of a coordinated notification mechanism among the hospitals, beneficiaries, and SNFs to ensure compliance with the 3-day rule. We noted that hospitals did not always provide correct [...]

iqtsupport2019-02-28T06:00:33-05:00February 28, 2019|Medicare reimbursement policy|

Government More Effective Than Private Sector at Controlling Health Care Costs

For the past dozen years, Medicare and Medicaid have done a better job of controlling rising health care costs than private insurers. Since 2016, according to a new report from the Urban Institute, private insurers’ costs per enrolled member have risen an average of 4.4 percent a year. By contrast, Medicare costs have risen an average of 2.4 percent per enrollee and Medicaid costs have risen just 1.6 percent per enrollee. The primary driver of Medicare cost increases has been prescription drug spending. For Medicaid the primary driver has been physician services and administrative costs. For private insurers, the main [...]

iqtsupport2019-02-13T06:00:47-05:00February 13, 2019|Medicaid, Medicare|

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services. In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments. Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided. Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities. Hospitals argue that their outpatient facilities are [...]

iqtsupport2019-01-30T06:00:38-05:00January 30, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, Medicare reimbursement policy|

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

iqtsupport2019-01-29T06:00:06-05:00January 29, 2019|Alternative payment models, hospitals, Medicare|

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|

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|

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|

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress. Among the findings included in the report by the Medicare Payment Advisory Commission are: Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays. Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted. MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities. MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for [...]

iqtsupport2018-06-21T10:33:14-04:00June 21, 2018|Accountable Care Organization, ACO, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, MedPAC, post-acute care|