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Policy

 

CMS Administrator Seema Verma, MPH, said the Trump administration will take the Center for Medicare and Medicaid Innovation (CMMI) in a “new direction,” claiming the policies under the last administration encouraged consolidation and providers need more “freedom” to design new care delivery models.

Once thought to be the policy equivalent of a Hail Mary pass, the plan to replace the Affordable Care Act (ACA) known as the Graham-Cassidy bill appears to have gained momentum—and with it, extra attention from healthcare industry groups like the American Medical Association (AMA) that have opposed Republicans’ so-far unsuccessful efforts to repeal the law.

Amid attempts to agree on short-term stabilization of the Affordable Care Act (ACA) and Democrats coming out in support for a “Medicare-for-all” bill, a group of Republican senators unveiled what could be their last chance to repeal and replace the ACA.

Members of the Senate Health, Labor, Education and Pensions (HELP) Committee were encouraged to offer greater flexibility under the Affordable Care Act’s “state innovation waivers,” the details of which could spell trouble for the fledging compromise between Democrats and Republicans on a quick fix for the law.

Legislation to move the U.S. to a single-payer, “Medicare-for-all” healthcare system will be introduced Wednesday, Sept. 13, by former presidential candidate Sen. Bernie Sanders, I-Vermont, with several potential presidential contenders in 2020 already lining up behind the bill. 

 

Recent Headlines

Senators Introduce Bill to Remove 96-hour Certification Requirement for CAHs

Efforts to remove a pre-admission requirement designed to shorten Medicare patient stays at more expensive critical access hospitals (CAHs) got a boost as a bi-partisan companion bill was introduced to advance a legislative fix in the Senate alongside efforts in the House.

ONC Announces 2015 Edition EHR Certification Criteria

To make the government’s electronic health record standard setting process more transparent, the Office of the Nation Coordinator for Health Information Technology (ONC) announced that it will begin issuing “voluntary” certification criteria on a more regular basis than it has in the past.

10 ICD-10 Questions Physician Senators Want CMS to Answer this Week

Concerned that the Centers for Medicare and Medicaid Services (CMS) plans for front-end testing of the ICD-10 system during the week of March 3 is too brief and too limited in scope, U.S. Senators and physicians Tom Coburn, M.D. (R-Okla.), John Barrasso, M.D. (R-Wyo.), John Boozman, O.D. (R-Ark.), and Rand Paul, M.D. (R-Ky.) have requested that the Centers for Medicare and Medicaid Services (CMS) answer their questions about the testing by February 26.

OIG to Look For Additional Kwashiorkor Fraudulent Billing in 2014

The 2014 Office of Inspector General (OIG) Workplan promises that the agency will look for more cases of hospitals miscoding malnutrition cases in Medicare patients as cases of kwashiorkor. Already this year, the agency has reached settlements with Mercy Medical Center, in Des Moines, Iowa, and Christus Saint Vincent Regional Medical Center, in Santa Fe, N.M., over incorrect billing for kwashiorkor in a combined total of 217 patients who actually did not have the disease.

5 Things the SGR Bill Does Besides Fix Doc Pay

The H.R. 4015/S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014, bills also contain provisions that impact more than just physician pay. Among the provisions tucked inside the bill are these five.

CMS Resets Clock on 2-Midnight Rule

A Centers for Medicare and Medicaid Services (CMS) decision to delay the date when Recovery Audit Contractors (RACs) will start looking for inpatient claims that should have been billed as outpatient observation because of their short duration (less than a day defined as two midnights in the hospital) will buy hospitals and the groups that represent them time to fight CMS-1599-F (commonly known as the “2-Midnight Rule”).

HHS Gives Patients Direct Access to Lab Results

The U.S. Department of Health and Human Services (HHS) has amended rules covering how laboratory test results are communicated to patients to allow patients to skip going through their physician to get access to their test results.

ACA Preparedness: How to Conduct a Community Health Needs Assessment

Non-profit hospitals have to do it every three years to comply with the requirements of the federal Patient Protection and Affordable Care Act (ACA), but probably any hospital or clinic would benefit by conducting a Community Health Needs Assessment (CHNA).

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