Payment & policy

CMS wants outpatient knee replacements to be covered

CMS wants outpatient knee replacements to be covered

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The Centers for Medicare & Medicaid Services has asked for coverage of knee replacement surgeries in outpatient facilities as part of a proposal concerning hospital outpatient prospective payments.

PPS comments are sought

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Federal regulators have agreed to gather more comments from providers and others on the revision of new skilled nursing prospective payment system case-mix methodology.

Family wins camera case

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The Minnesota Department of Health ruled against a provider recently in a closely watched case involving a surveillance camera in a resident room.

MedPAC calls for payment reforms to come even earlier

MedPAC calls for payment reforms to come even earlier

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Federal lawmakers' advisory panel for Medicare made it official in its report to Congress in June: It recommends implementation of a unified post-acute payment system beginning in 2021 — three years earlier than first proposed.

Court: Medicaid may collect SNF room-and-board outlays

Court: Medicaid may collect SNF room-and-board outlays

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In a ruling that could create ripple effects on state Medicaid programs around the country, Nebraska's highest court decreed that the state may pursue payment from beneficiaries for room-and-board costs for skilled nursing stays.

ACOs cut costs, not quality

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Post-acute care spending dropped by 9% — or about $106 per beneficiary — without a drop in quality, a study of accountable care organizations in the Medicare Shared Savings Program has found.

Bundled pay expansion into cardiac care held 3 months

Bundled pay expansion into cardiac care held 3 months

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Federal regulators have postponed the implementation of the extension of a bundled pay program that was to start including cardiac care treatments. Some observers believed it could be a precursor to a permanent delay or halt to related projects.

ACO reduces medical costs

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An examination of Part D drug spending during the first year of an accountable care organization discovered that medical costs went down and prescription drug spending did not rise.

GAO reports assail Medicaid oversight, provider vetting

GAO reports assail Medicaid oversight, provider vetting

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The Government Accountability Office recently issued a pair of reports within days of one another critical of how the Medicaid program gathers data and screens its provider participants.

BCPI ups quality: analysis

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A recent analysis shines a positive light on value-based care models such as federal hip and knee replacement bundled payment programs.

A bundle of good pay news on joint replacement model

A bundle of good pay news on joint replacement model

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Strong reviews for one of the most scrutinized bundled payment programs in the country indicate additional similar programs could be in providers' future.

OIG: Policy cut SNF care

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Investigators with the Office of Inspector General are recommending a closer look at federal regulators' controversial "two-midnight" rule for Medicare beneficiaries.

New ACO designed to better serve dual eligibles strategy

New ACO designed to better serve dual eligibles strategy

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The Centers for Medicare & Medicaid Services announced Dec. 15 it was starting an ACO pilot program aimed at beneficiaries enrolled in both Medicare and Medicaid.

Medicare appeals backlog to be fixed by 2020, HHS says

Medicare appeals backlog to be fixed by 2020, HHS says

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Federal health officials say tweaks to the system will enable them to eradicate a massive backlog of Medicare decision appeals in 2019. They made the prediction in a court brief filed in U.S. District Court for the District of Columbia in early November.

Focus: Readmission rates

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Rehospitalization rates should continue to be a strong focal point for gauging providers' efficacy in future payment arrangements.

Quicker start is possible for unified payments: MedPAC

Quicker start is possible for unified payments: MedPAC

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Thanks to the creation of models that would use data already collected by federal officials, post-acute providers could be using a unified Medicare payment system sooner than expected, officials say.

Bundled pay cuts LOS, use

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The Bundled Payments for Care Improvement initiative is already showing promising results, researchers said.

Study casts doubt on future of value-based purchasing

Study casts doubt on future of value-based purchasing

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Even as some experts were predicting that value-based purchasing initiatives would be expanding in the near future, researchers from a handful of universities were casting doubts on the success of a VBP demo project.

Court: Racial taunts? Tough

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A patient making threats about being cared for by someone of a race he or she doesn't like is not a valid reason for a provider to assign staffing by race, a court has ruled.

Camera policies held up by privacy, litigation concerns

Camera policies held up by privacy, litigation concerns

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In the battle of pros and cons for placing cameras in resident rooms, the potential negative legal and privacy implications are winning out with most providers, new research shows.

Person-centered care saves

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Skilled nursing operators can expect healthcare stakeholders to push for more person-centered care programs because of the wide savings they appear to offer payers.

Insurers rattled by Medicaid managed care's big changes

Insurers rattled by Medicaid managed care's big changes

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The government's first major overhaul of the Medicaid Managed Care program in 14 years is unlikely to affect provider reimbursements, but insurers continue to take exception with one provision allowing beneficiaries to switch plans if their providers are dropped.

More MDS tweaks coming

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Providers must ensure accuracy of their own internal databases before the latest iteration of the minimum data set, or MDS 3.0, becomes effective October 1, a prominent coding consultant emphasizes.

Analysis: PAC crucial to joint replacement bundled success

Analysis: PAC crucial to joint replacement bundled success

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Hospitals participating in a new Medicare bundled payment program for hip and knee replacements should partner with high quality post-acute care providers like nursing homes within the first 90 days following surgeries, a recent analysis by Avalere Health finds.

'Illusion' can raise costs

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In an effort to improve the use of medical treatments, a University of Pennsylvania Medical School professor is calling for more research to help doctors recognize and manage what some call a "therapeutic illusion."

Groups tout payment plans; Pallone promises legislation

Groups tout payment plans; Pallone promises legislation

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Several organizations have weighed in on how to finance long-term care services and supports for more than 12 million Americans, leading a Congressional committee to push toward a possible legislative remedy later this year.

Right-to-try gains support

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Congress is considering easing federal laws prohibiting terminally ill patients from trying unapproved experimental drugs as a last-ditch effort to extend or save their lives.

CMS: Regional spending is a better benchmark for ACOs

CMS: Regional spending is a better benchmark for ACOs

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The government hopes to encourage accountable care organizations to extend their participation in performance-based risk arrangements by offering a new way to include payments based on regional spending fee-for-service costs. The comment period on the proposal ends March 28.

No 'midnight' regulations?

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Stakeholders have until roughly mid-June to squeeze in any pressing new regulations during the current administration's final year. But the Office of Management and Budget said it doesn't expect any major surprises in 2016.

Agencies seek feedback on quality measure reporting

Agencies seek feedback on quality measure reporting

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Nursing homes were allowed a 30-day window last month to give the Centers for Medicare & Medicaid Services a piece of their mind about the way the agency certifies and tests electronic health record products.

CMS releases DMEPOS rule

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Providers will face new rules in March that change the way they're reimbursed for certain types of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

GAO: Managed care growth putting Medicaid funds at risk

GAO: Managed care growth putting Medicaid funds at risk

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End-of-year comments from the comptroller general indicated ways the Medicaid and Medicare programs can continue to improve, including the Centers for Medicare & Medicaid Services increasing its oversight of Medicaid managed care program integrity.

Rise in improper payments

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Improper payment levels continue dogging the Centers for Medicare and Medicaid Services, which announced they rose significantly last year for both health programs. Additionally, the agency reported that collections were down more than $1.5 billion.

Medicare overpayment rule might take effect in February

Medicare overpayment rule might take effect in February

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Barring objections from the Office of Management and Budget, the Centers for Medicare & Medicaid Services will implement a new rule early next year aimed at retrieving hundreds of millions of dollars of provider overpayments dating back to 2010.

OIG: Tougher 2016 probes

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Providers should expect more aggressive federal efforts to investigate healthcare fraud cases as the Department of Health & Human Services makes use of sophisticated data analytics in the coming year.

MedPAC begins working on unified post-acute pay plan

MedPAC begins working on unified post-acute pay plan

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The Medicare Payment Advisory Commission is devising a plan that would pay skilled nursing facilities, inpatient rehabilitation facilities, home health agencies and long-term care hospitals under a unified prospective payment system.

Providers fret bundled pilot

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Provider advocates generally accept a proposal to bundle Medicare payments for one of the most common orthopedic procedures, but many believe the plan is being rushed while serious concerns about issues such as payment incentives and financial risks aren't being addressed.

Risky business: Program lets provider sell health insurance

Risky business: Program lets provider sell health insurance

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This month, one of the country's largest skilled nursing facility operators will begin offering its Kentucky-based members health insurance.

SNFs embrace bundled pay

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Many healthcare providers are willing to accept bundled payments from Medicare well before it's mandated, according to new data from research firm Avalere Health.

Net gain for rural operators

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Skilled nursing facilities would become eligible for broadband services funding under a proposed Senate bill.

Medicaid termination doesn't always cross state lines: OIG

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Twelve percent of providers terminated from a state Medicaid program continued participating in other states, a new government study has found.

Ask the Payment Expert about ... expedited review

Ask the Payment Expert about ... expedited review

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The expedited review process was developed so a resident could quickly appeal the process if he or she disagreed when a facility decided that a resident is no longer covered under skilled services.

State's Medicaid managed care data lacking, OIG says

State's Medicaid managed care data lacking, OIG says

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The Office of the Inspector General recommended that the Centers for Medicare & Medicaid Services withhold federal funds from states that do not accurately report encounter data under their Medicaid managed care plans.

House IPAB repeal advances

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The House of Representatives voted in June to repeal the Independent Payment Advisory Board, a Medicare cost containment entity created under the Affordable Care Act.

3-day rule waiver in new ACO rule; LTC to take on more risk

3-day rule waiver in new ACO rule; LTC to take on more risk

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Federal regulators have upped the ante for providers taking part in an accountable care organization model, with potentially more money going into long-term care.

Managed care: Fear awaits

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The White House Office of Management and Budget review has passed an ambitious new policy that could radically overhaul the Medicaid managed care system.

Providers challenge proposal that adjusts payments, care

Providers challenge proposal that adjusts payments, care

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Providers in the post-acute care sector seem to be united in wanting BACPAC to take a hike.

Patient CARE Act is probed

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Because it does not allow for states' consent, the proposed Medicaid Patient CARE Act block-grant program likely will be considered unconstitutional, say two public policy authorities.

Ask the Payment Expert ... about Change of Therapy assessment

Ask the Payment Expert ... about Change of Therapy assessment

A COT is required when the RUG level increases or decreases. If you do not complete a COT when required, you will be considered to have a late or missed assessment.

Interoperability pressured

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Congress is getting more involved in healthcare interoperability. Lawmakers have proposed legislation calling for changes to the process in order to speed up and broaden provider inclusion by the end of 2018.