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Policy

 

CMS’s move to cut Medicare payments made through the 340B drug discount programs would see the biggest impact in California, New York and North Carolina, according to an analysis by Avalere Health, though for most hospitals it will reduce their total Part B revenue by less than 5 percent.

The Affordable Care Act’s taxes on health insurance, high-cost health plans and medical devices would be delayed under a series of bills introduced by House Republicans, with the Medical Imaging & Technology Alliance (MITA) quickly coming out in support of suspending the device tax.

Two Senate Democrats have asked CMS and HHS to make a last-minute extension of the open enrollment period for the Affordable Care Act (ACA)’s insurance exchanges, arguing the Dec. 15 deadline will leave too many interested customers either without health coverage or automatically enrolled into plans which “may no longer be the best choice for their families.”

The repeal of the Affordable Care Act’s individual mandate has been projected to cause insurance premiums to rise by an average of 10 percent through 2027. Those hikes would be mitigated, however, if Congress funded the ACA’s cost-sharing reduction subsidies and a $10 billion, two-year reinsurance program, according to an analysis from Avalere.

The American Hospital Association (AHA) suggested the Medicare Payment Advisory Commission (MedPAC) pump the brakes on advocating for major changes to Merit-based Incentive Payment System (MIPS), saying any major shifts wouldn’t have “the benefit of data or experience” considering this is the program’s first performance year.

 

Recent Headlines

Beneficiaries now also suing about long wait for Medicare appeals hearings

Earlier this year, the American Hospital Association (AHA) and three hospital and healthcare systems sued the U.S. Department of Health and Human Services (HHS) over the long backlog in Medicare claim denial appeals. Now patients are joining in with a nationwide class action suit.

Senators introduce bill to continue higher Medicaid rates for primary care

With the provision in the Affordable Care Act that provides federal money to states to help them make their Medicaid payment rates for primary care match Medicare rates set to expire at the end of this year, Democratic Senators have introduced a bill to continue federal support for higher Medicaid rates for two more years.

CMS extends Sunshine Act records review deadline, tosses a third of reported data

Physicians and teaching hospitals now have until September 8, 2014, to review payment information manufacturers and group purchasing organizations have submitted to the government about them as the Centers for Medicare and Medicaid Services (CMS) had to take its online Open Payments verification system down for nearly two weeks to fix glitches and problems with the reported data.

Sunshine act payments verification process may be even more cumbersome than you think

The American Medical Association (AMA) is doing a full court press to get every member to verify his or her industry payments well before the August 27 deadline to dispute reported data because the process is turning out to be longer and more glitch prone than many anticipated.

Hospitalists urge Congress to can observation status

A report released today from the Society of Hospital Medicine in conjunction with its testimony before the Senate Special Committee on Aging urges a significant overhaul of the Centers for Medicare and Medicaid Services (CMS) policy on observation status and two-midnight rule definition for inpatient status.

N.J. health commissioner report pushes for full financial transparency for all hospitals

A report released late Friday by New Jersey’s health commissioner, Mary O’Dowd, recommends that the state require that all hospitals, public and private, for-profit and non-profit, publish their quarterly unaudited financial statements on their websites within 45 days of each quarter’s end, and their annual audits within 180 days of the close of a hospital’s fiscal year.

Sunshine rule off to rocky start as doctors encounter error messages on reporting site

Physicians attempting to log in to the Open Payments website to verify information reported about them ahead of that information being made public are encountering a cumbersome log-in process and confusing error messages, reports ProPublica.

AHA and hospitals seek summary judgment in claim denial appeals backlog case

Noting that by their estimates, billions in disputed claims are tied up in the current appeals process for denied Medicare claims and this is causing severe harm to hospitals, the American Hospital Association along with the hospital operators Baxter Regional Medical Center, Covenant Health, and Rutland Regional Medical Center, have asked a Washington, D.C., court to issue a summary judgment in their favor and compel the U.S. Department of Health and Human Services (HHS) to honor the law’s requirement that disputed claims be heard by an Administrative Law Judge (ALJ) within 90 days.

Proposed MPFS seeks to boost payments to primary care

The Centers for Medicare & Medicaid Services (CMS) used the proposed 2015 Medicare Physician Fee Schedule (MPFS) to create some carrots and sticks to encourage moving the care of more patients, particularly the growing percentage of beneficiaries with multiple chronic illnesses, into the lower-cost outpatient primary care setting.

CMS releases proposed 2015 hospital OPPS and ASC rates

The Centers for Medicare and Medicaid Services (CMS) has proposed a 2.1 percent market basket update for services paid under the hospital Outpatient Prospective Payment System (OPPS) in 2015 and to update Ambulatory Surgery Center (ASC) payments by 1.2 percent next year.

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