Payment & policy

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.

Ask the payment expert ... about RACs

Ask the payment expert ... about RACs

I thought the Recovery Audit Contractors were on hold, so why did I receive a request from our RAC for a Medicare Advantage resident?

RAC battles move forward

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The debate over whether Recovery Audit Contractor audits are an incentive-laced system of provider harassment or a necessary tool to redistribute misspent Medicare funds continues. Neither side appears to be backing down

White House forums eyeball Medicaid funding concerns

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The White House Conference on Aging is collecting comments from long-term care stakeholders through a series of regional forums across the U.S. about their concerns regarding the future of Medicaid funding.

Bill would cover telehealth

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In a move that could greatly expand the visibility and adoption of telehealth systems, Congress is proposing that Medicare reimburse telehealth services at the same rate as in-person medical visits.

MedPAC changing tune on hospital observation stays?

MedPAC changing tune on hospital observation stays?

Long-term care providers' hopes for eliminating hospital observation stays may be fading after some Medicare Payment Advisory Commission members said they were re-thinking their positions on changing the policy.

Managed care taking hold

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Medicaid fee-for-service is in a steep decline, and signs suggest trends will continue in their current direction, a new report reveals.

Politicians pressure auditors to back down, paper claims

Politicians pressure auditors to back down, paper claims

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The prospects of politician intervention with Medicare audits has sparked some debate over whether elected officials are exerting undue influence, or simply defending providers' rights against government overreaching.

Dual-eligible future cloudy

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The National Association of Medicaid Directors is asking for more guidance on the dual-eligible program and for regulators to "articulate next steps for existing financial alignment demonstrations."

HHS gives shooter guidance for healthcare facilities

HHS gives shooter guidance for healthcare facilities

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Federal agencies have issued guidance for how healthcare providers should prepare for an active shooter emergency. The 33-page document covers threat assessment, actions to take during and after an emergency, and other best practices.

States eye Medicaid hikes

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In a sign that the economy continues its recovery from the devastating recession of 2008, most states are committed to raising Medicaid fees in fiscal years 2014 and 2015, research from the Kaiser Family Foundation's Commission on Medicaid has found.

Medicare coverage kicks in, 2 years after landmark win

Medicare coverage kicks in, 2 years after landmark win

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Seven years after filing for Medicare benefits for diabetes complications, Glenda Jimmo of Bristol, VT, finally qualified for skilled home health maintenance coverage. The obstacle that caused the long delay was Medicare's "improvement standard," which officials used to deny coverage for beneficiaries deemed to be "unlikely to improve."

RACs snatch back $1.8M

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Recovery Audit Contractors collected $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released in late September.

CMS should push Congress on therapy rate upgrades: AHCA

CMS should push Congress on therapy rate upgrades: AHCA

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The Centers for Medicare & Medicaid Services should openly urge Congress to change therapy reimbursement, the nation's largest long-term care provider association stated in recent written comments to CMS Administrator Marilyn Tavenner.

Hospice billings changed

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The Centers for Medicare & Medicaid Services recently updated instructions on coding hospice claims. Billing staffs should be aware of these changes, which went into effect Oct. 1, CMS stated in a memorandum about the Medicare manual update.

Latest ACO dropout blames issues with payment system

Latest ACO dropout blames issues with payment system

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A California healthcare system recently became the latest dropout from the Pioneer Accountable Care Organization program, citing the fact that payments are not adjusted by region. Sharp HealthCare announced the move in its third-quarter financial report.

Bill could gut scheduling

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A Congressional proposal to provide low-wage hourly employees with more stability and workplace protections could hit nursing homes.

RACs return $100 million to providers, as criticism grows

RACs return $100 million to providers, as criticism grows

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Medicare Recovery Audit Contractors returned a record $100.4 million in identified underpayments to providers between April and June.

Hospitals: Change SNF pay

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The government should adopt Medicare payment policies that better support hospital-based skilled nursing facilities, the American Hospital Association urged in a recent letter to a top healthcare official.

Better anti-fraud efforts are not appeasing lawmakers

Better anti-fraud efforts are not appeasing lawmakers

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Long-term care facilities and other Medicare providers increasingly have seen reimbursements influenced by the government's Fraud Prevention System, an official recently told a Congressional panel.

Panel slams fee for service

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The predominance of fee-for-service payment methods is the greatest barrier to improving efficiency in the nation's healthcare system, according to a May 29 report from a panel of White House advisors. The President's Council of Advisors on Science and Technology criticized the FFS payment model because it focuses on the volume of services provided rather than on better outcomes.

Referrals funnel duals into lower quality nursing homes

Referrals funnel duals into lower quality nursing homes

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Government health programs could save money and health outcomes could improve if more dual-eligible beneficiaries were to go from hospitals to well-staffed long-term and post-acute facilities, according to research from Brown and Harvard universities.

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