Wednesday, April 30, 2014
Tuesday, April 29, 2014
Monday, April 28, 2014
Sunday, April 27, 2014
Thursday, April 24, 2014
Wednesday, April 23, 2014
Audit Contractors Unlikely to Duplicate 2013 Medicare Recovery Haul Amid Dispute
Audit Contractors Unlikely to Duplicate 2013 Medicare Recovery Haul Amid Dispute
By Kerry Young, CQ HealthBeat Associate Editor
Recovery audit contractors successfully challenged about $3.7 billion in questionable Medicare payments in fiscal 2013, a success rate they’re unlikely to duplicate any time soon due to constraints Congress imposed on the industry.
The fiscal 2013 results marked a gain of about 60 percent, compared to the $2.3 billion recovered for Medicare in the previous year, according to an April Department
“At the end of fiscal year 2013, the Recovery Audit Contractor program was returning over $1 billion per quarter to the Medicare Trust Fund,” said Rebecca Reeves, a spokeswoman for the American Coalition for Healthcare Claims Integrity, which represents these auditing firms, in a statement. “The recent constraints place on the RAC program will dramatically reduce this pace.”
Hospitals, the main target of the contractors, have since succeeded in getting Congress to at least temporarily rein in these firms. A “doc fix” bill (PL 113-93) largely sidelined the contractors through March 2015. Intended primarily to stop a mandated cut in doctors’ pay, the measure also would delay some enforcement of a controversial two-midnight rule on hospital stays used to assess whether Medicare admissions were legitimate.
Hospitals have been fighting the policy, saying they could absorb significant losses if auditors successfully challenge decisions to admit patients for stays lasting less than two days (See CQ HealthBeat, Feb. 7, 2014 ). The American Hospital Association last week said that it filed two related lawsuits against HHS challenging the two-midnight rule. The actions contend that provisions in the Centers for Medicare & Medicaid Services’ final inpatient prospective payment rule for 2014 “burden hospitals with unlawful arbitrary standards and documentation requirements and deprive hospitals of proper Medicare reimbursement for caring for patients.”
Seeking to address disputes between the contractors and the hospitals on what constitutes an appropriate inpatient stay, CMS last year put forward a new test for deciding this question. To be considered an inpatient stay, the admitting physician must expect that the patient will need care in the hospital for a period spanning at least two midnights.
The hospital trade group contends that CMS’s own data show that many conditions, including heart attacks, concussions and even “comas without complications” and surgeries such as appendectomies and mastectomies routinely involve short stays that don’t span two midnights. The hospital group said that the two-midnight standard “defies common sense.”
“The word ‘inpatient’ simply doesn’t mean ‘a person who stays in the hospital until Day 3,’ and CMS is not at liberty to change the meaning of words to save money,” the association said in its legal filing.
Hospitals have much to lose. Medicare generally pays them more if a patient is considered admitted and thus qualifies for the federal health program’s Part A payments. Part B is in general intended for payment for outpatient care.
“(T)ypically, years later— a RAC will overrule the physician’s decision to admit the patient on the ground that, in the RAC’s opinion, the patient could have been treated in the outpatient setting, and as a result, CMS will take back the entire Part A payment amount,” the hospital association said in its legal brief, which was filed in the U.S. District Court for the District of Columbia.
While Congress may not address the rule or other health policy in the months ahead, lawmakers have shown interest in the issue. Rep. Sam Graves, R-Mo., has at least 111 Republican and 93 Democratic backers for a bill (HR 1250) that would add new requirements on the contractors. The bill, first introduced in March 2013, has been attracting support at a steady pace since, gaining eight new cosponsors last month. The measure also would also provide the hospitals with potential aid, such as a provision requiring that a physician review each claim denial of a claim for medical necessity made by an employee of the contractor who is not a physician.
But the recovery audit contractors do have support from groups such as Citizens Against Government Waste, which has blasted Graves ’ bill.
“Perhaps unsurprisingly, the success of recovery auditors in particular has raised hackles among providers, particularly hospitals, whose claims constituted the vast majority (88 percent) of the overpayments identified by the RACs. Even though the hospitals were not entitled to the money in the first place, they have called RACs `bounty hunters,’ complaining that their contingency fee compensation model pushes them to be exceedingly aggressive in challenging claims,” the group said in its statement about the Graves bill.
Tuesday, April 22, 2014
CHIP Advocates Cast Wary Eye on the Calendar
CHIP Advocates Cast Wary Eye on the Calendar
By John Reichard, CQ HealthBeat Editor
Champions of the Children’s Health Insurance Program are starting to worry about its future with federal funding set to expire in 18 months and new coverage alternatives available under the health law.
A central question is whether advocates can convince Congress the program covering 8.5 million children is worth keeping even though states now have the option of expanding their Medicaid programs to help cover that population. Lawmakers also authorized hundreds of billions of dollars in subsidies to buy coverage on insurance exchanges.
Even if the programs supporters succeed, it’s not clear for how long. And if Congress waits until the last minute to act, leaving CHIP’s funding outlook uncertain, advocates may have to talk state legislators out of capping CHIP enrollment and taking other steps to control costs.
Right now, it looks like Congress may extend CHIP funding through fiscal 2017, if not longer. But whether it will fund the program as generously as it does now is unclear. So is the timing of congressional action.
CHIP’s fate was foremost on the mind of Sen. Jay Rockefeller, D-W.Va. when he questioned HHS Secretary Kathleen Sebelius at a Senate Finance Committee hearing April 10.
“We’re funded, you know, through this year and part of next and then it just stops,” he said. A 2009 law (PL 111-3) reauthorized CHIP through fiscal 2013, and the health law (PL 111-148, PL 111-152) tacked on another two years of funding through Sept. 30, 2015.
Rockefeller said he wanted to understand whether President Barack Obama and HHS officials want to maintain the program “for a period of years and years, because right now, it just strikes — it’s strange that he hasn’t mentioned it.”
Sebelius attempted a soothing response that fell short because she gave no assurances.
“We’re going to see more children gaining benefits than ever before,” she said, in part because of a simplified CHIP and Medicaid application process. Rockefeller agreed but said he’d be happy if Obama in one of his press conferences “just mentioned it.”
“ It’s just odd to me knowing him and his commitments, that he just simply hasn’t mentioned it at all,” the senator said.
The panel Congress created under the health law to advise it on CHIP and Medicaid said at a meeting the next day it isn’t committed to having a standalone coverage program like CHIP continue indefinitely. It cited what it called “new affordability options” through the health law as the reason.
But children’s advocacy groups like First Focus say coverage sold on insurance exchanges isn’t as generous as that offered by CHIP. And the advisory panel whose formal title is the Medicaid and CHIP Payment and Access Commission, or MACPAC, echoed that concern. An analysis by its staff said if CHIP funding runs out after fiscal 2015, the number of uninsured children could increase significantly. Cost-sharing also could rise for many families.
It’s “unclear whether or not exchange plans are ready to serve as an appropriate alternative,” the analysis stated.
The panel voted April 11 to recommend to Congress that it extend CHIP funding through fiscal 2017. That transitional step would allow issues relating to the affordability and adequacy of children’s coverage in the absence of CHIP to be addressed, the panel said.
A Senate GOP aide said the recommendation “definitely has legs” on Capitol Hill depending on how the Congressional Budget Office scores its cost. MACPAC has asked CBO to score both a two-year and a four-year extension, and the score could be released at any time, the aide said.
Obama administration officials are “sitting on their hands right now and waiting to decide what they want to do here.”
Both Republicans and Democrats face quandaries on a program extension. Republicans may not want to continue current levels of federal funding but risk political fallout if they move to take coverage away from children at a time when they’re trying to regain control of the Senate and win the White House in 2016.
Meanwhile, Democrats who endorse extending CHIP could be seen as tacitly admitting that the health law isn’t working the way it’s supposed to. “Everybody has an incentive to do this early not late,” the aide said concerning an extension.
But Congress often dawdles until the last minute. Both Senate Finance Committee Chairman Ron Wyden, D-Ore., and the panel’s top Republican Orrin G. Hatch of Utah “may keep their cards close to the vest” on the issue. But the aide predicted Rockefeller will introduce legislation this year — his last before retiring — to prod lawmakers.
By John Reichard, CQ HealthBeat Editor
Champions of the Children’s Health Insurance Program are starting to worry about its future with federal funding set to expire in 18 months and new coverage alternatives available under the health law.
A central question is whether advocates can convince Congress the program covering 8.5 million children is worth keeping even though states now have the option of expanding their Medicaid programs to help cover that population. Lawmakers also authorized hundreds of billions of dollars in subsidies to buy coverage on insurance exchanges.
Even if the programs supporters succeed, it’s not clear for how long. And if Congress waits until the last minute to act, leaving CHIP’s funding outlook uncertain, advocates may have to talk state legislators out of capping CHIP enrollment and taking other steps to control costs.
Right now, it looks like Congress may extend CHIP funding through fiscal 2017, if not longer. But whether it will fund the program as generously as it does now is unclear. So is the timing of congressional action.
CHIP’s fate was foremost on the mind of Sen. Jay Rockefeller, D-W.Va. when he questioned HHS Secretary Kathleen Sebelius at a Senate Finance Committee hearing April 10.
“We’re funded, you know, through this year and part of next and then it just stops,” he said. A 2009 law (PL 111-3) reauthorized CHIP through fiscal 2013, and the health law (PL 111-148, PL 111-152) tacked on another two years of funding through Sept. 30, 2015.
Rockefeller said he wanted to understand whether President Barack Obama and HHS officials want to maintain the program “for a period of years and years, because right now, it just strikes — it’s strange that he hasn’t mentioned it.”
Sebelius attempted a soothing response that fell short because she gave no assurances.
“We’re going to see more children gaining benefits than ever before,” she said, in part because of a simplified CHIP and Medicaid application process. Rockefeller agreed but said he’d be happy if Obama in one of his press conferences “just mentioned it.”
“ It’s just odd to me knowing him and his commitments, that he just simply hasn’t mentioned it at all,” the senator said.
The panel Congress created under the health law to advise it on CHIP and Medicaid said at a meeting the next day it isn’t committed to having a standalone coverage program like CHIP continue indefinitely. It cited what it called “new affordability options” through the health law as the reason.
But children’s advocacy groups like First Focus say coverage sold on insurance exchanges isn’t as generous as that offered by CHIP. And the advisory panel whose formal title is the Medicaid and CHIP Payment and Access Commission, or MACPAC, echoed that concern. An analysis by its staff said if CHIP funding runs out after fiscal 2015, the number of uninsured children could increase significantly. Cost-sharing also could rise for many families.
It’s “unclear whether or not exchange plans are ready to serve as an appropriate alternative,” the analysis stated.
The panel voted April 11 to recommend to Congress that it extend CHIP funding through fiscal 2017. That transitional step would allow issues relating to the affordability and adequacy of children’s coverage in the absence of CHIP to be addressed, the panel said.
A Senate GOP aide said the recommendation “definitely has legs” on Capitol Hill depending on how the Congressional Budget Office scores its cost. MACPAC has asked CBO to score both a two-year and a four-year extension, and the score could be released at any time, the aide said.
Obama administration officials are “sitting on their hands right now and waiting to decide what they want to do here.”
Both Republicans and Democrats face quandaries on a program extension. Republicans may not want to continue current levels of federal funding but risk political fallout if they move to take coverage away from children at a time when they’re trying to regain control of the Senate and win the White House in 2016.
Meanwhile, Democrats who endorse extending CHIP could be seen as tacitly admitting that the health law isn’t working the way it’s supposed to. “Everybody has an incentive to do this early not late,” the aide said concerning an extension.
But Congress often dawdles until the last minute. Both Senate Finance Committee Chairman Ron Wyden, D-Ore., and the panel’s top Republican Orrin G. Hatch of Utah “may keep their cards close to the vest” on the issue. But the aide predicted Rockefeller will introduce legislation this year — his last before retiring — to prod lawmakers.
Monday, April 21, 2014
Thursday, April 17, 2014
Wednesday, April 16, 2014
Tuesday, April 15, 2014
Monday, April 14, 2014
Sunday, April 13, 2014
Thursday, April 10, 2014
Tuesday, April 8, 2014
Monday, April 7, 2014
Sunday, April 6, 2014
Friday, April 4, 2014
Emory and Grady Join Georgia's First Statewide Electronic Health Information Exchange
Emory and Grady Join Georgia
Secure network improves patient-centered care and health outcomes
PR Newswire
"Traditionally, patient health information has been difficult to share across care settings," said Denise Hines, executive director of GaHIN. "By connecting Emory and Grady to GaHIN, they can now provide its care delivery teams with comprehensive and up-to-date information on which to base care decisions."
Created as a public-private partnership under the leadership of the Department of Community Health (DCH), Health IT Division, GaHIN's ConnectedCare technology gives its members the ability to access a more complete view of their patients' health information directly from their electronic health record (EHR) systems. This minimizes manual and often time-consuming processes. Patients also benefit as GaHIN helps to gather information from multiple sources and provide this information to the caregiver at the time of service. This improves care coordination, which can help reduce adverse events, complications, hospital readmissions and duplicative testing.
"This collaborative effort between the public and private sectors is a significant step for Georgia
Providers at Emory and Grady can improve both direct care delivery and coordination by having ever-present access to clinical information, such as Medicaid health and pharmacy information and immunization updates and reporting from the Georgia Registry of Immunization Transactions and Services (GRITS), managed by the Department of Public Health.
"Health information exchange is THE critical technology path to care coordination across all domains of care," said Dee Cantrell, CIO, Emory Healthcare. "We are quite excited and pleased to be the first health system in Georgia
Deborah Cancilla, SVP, CIO of Grady Health system stated, "Being on the leading edge of technological advances that improve patient care is a key component of Grady's transformation, as we continue to improve operational efficiencies and enhance the patient experience." She continued, "Understanding the industry trend towards empowering the patient and making their health information more readily available is another important reason for Grady's GaHIN membership."
With GaHIN, providers will be able to take advantage of existing and future services including lab routing, admission, discharge and transfer alerts, as well as future inter-operability through a nationwide Health Information Exchange.
About Georgia Health Information Network
The Georgia Health Information Network (GaHIN) is a nonprofit organization dedicated to the use and exchange of electronic health information to foster a healthier Georgia
About The Georgia Department
Through effective planning, purchasing and oversight, the Georgia Department of Community Health (DCH) provides access to affordable, quality health care to millions of Georgians, including some of the state's uninsured and most vulnerable populations.
DCH is responsible for Medicaid and PeachCare for Kids,® the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology inGeorgia
DCH is responsible for Medicaid and PeachCare for Kids,® the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in
Clyde L. Reese III, Esq., serves as Commissioner for the Georgia Department of Community Health.
Wednesday, April 2, 2014
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