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News In Healthcare
New Web-Based Service Helps Hospitals Reduce the Risk of Medicare Overpayments, Rejected Claims and Other Billing Problems – August 2008 Billing errors are driving almost all large repayments made to the U.S. government by hospitals...and recovery audit contractors (RACs) identified and corrected $357 million in FY 2007 Medicare overpayments in three states alone. To help insulate your facility from compliance hassles and multi-million dollar Medicare repayments, AIS has teamed up with Strategic Management Systems, Inc. (SMSInc.), led by former HHS Inspector General Richard P. Kusserow, to launch High-Risk Areas in Medicare Billing: Compliance and Auditing Tools for Hospitals and Health Systems .
Read the full article from AIS Health.com.
They’re Back: Harry and Louise on Health Insurance – August 2008
Read the full article from AP/Yahoo News.
Hospital prices increase 0.2% in July - August 2008 Overall hospital prices increased 0.2% in July, and were 3.2% higher than a year ago, the Bureau of Labor Statistics reported today. Prices at general medical and surgical hospitals increased 0.2%, and were 3.4% higher than in July 2007, according to the BLS' Producer Price Indices, which measure average changes in selling prices received by domestic producers for their output. For hospitals, this translates into actual or expected reimbursement for a sample of treatments or services. The PPI for hospitals measure changes in actual or expected reimbursement received for services across the full range of payer types. This includes the negotiated contract rate from the payer plus any portion expected to be paid by the patient.
CMS Issues Report on Medicare RAC Demonstration - July 2008 After months of delay, the Centers for Medicare & Medicaid Services today released a new report on the Medicare Recovery Audit Contractor three-year demonstration program. According to the report, RACs recouped $992.7 million in overpayments to providers, while $37.8 million in underpayments were repaid to providers as of March 27. Of the overpayments, 85% were collected from inpatient hospital providers, 6% from inpatient rehabilitation facilities and 4% from outpatient hospital providers. After expenses, appeals and underpayments repaid to providers, the program returned $693.6 million to the Medicare Trust Fund; however, CMS notes that this amount is subject to change depending on the outcome of pending appeals. The report also outlined lessons learned during the demonstration and improvements CMS will make to the permanent program scheduled to roll-out later this summer. AHA Vice President for Policy Don May said, “We’ve worked hard to identify RAC problems and the report highlights several improvements CMS is implementing to make the permanent program fairer and less burdensome to hospitals. We appreciate these changes but more changes are needed.” The AHA-backed Medicare Recovery Audit Contractor Program Moratorium Act (H.R. 4105), introduced by Reps. Lois Capps (D-CA) and Devin Nunes (R-CA), would place a one-year moratorium on the RAC program. RACs identify Medicare overpayments and underpayments, and receive a percentage of the overpayments they collect from providers.
AHA Comments on Homeland Security Advisory System - July 2008 In a comment letter today, the AHA expressed concerns with the Homeland Security Advisory System as applied to the nation’s hospitals. “Most importantly, hospitals believe that a five-stage alert and response system does not fit with the way in which hospitals respond to disasters,” AHA said, a concern also expressed in a 2002 letter to former Homeland Security Secretary Tom Ridge. In addition, AHA said hospital preparedness staff are concerned that the HSAS for Healthcare and [the] Public Health Sector was last updated on Feb. 25 but not shared with the private sector until June 28, leaving less than two weeks to comment, including a national holiday weekend. “If DHS genuinely seeks field input, a longer comment period must be provided,” AHA said. Today’s letter to the Department of Homeland Security can be found at www.aha.org.
HHS Issues Report on Project Bioshield Progress - July 2008 The Department of Health and Human Services yesterday issued a progress report for Project BioShield, authorized by Congress in 2004 to develop and acquire medical countermeasures for chemical, biological, radiological and nuclear events. During the August 2006 to July 2007 reporting period, anthrax vaccine developed under a $242.7 million contract was delivered to the Strategic National Stockpile. In addition, a pediatric formulation of potassium iodide was delivered to the stockpile under a $17.5 million contract to protect the thyroid gland after a nuclear or radiological event. HHS also awarded $4 million in grants to national laboratories and universities to research agents that help eliminate radioactive substances from the body, and made payments toward a $500 million contract to develop a new smallpox vaccine for people with compromised immune systems, among other activity.
AMA Apologizes for History of Racial Inequality - July 2008 The American Medical Association today apologized for its “past history of racial inequality toward African-American physicians,” prompted by a study to be published in the July 16 issue of the Journal of the American Medical Association. The study, by an independent panel of experts convened by the AMA, analyzes the “historical roots of the black-white divide in U.S. medicine” based on a review of materials from the AMA, National Medical Association, newspapers and other sources. In summary, the panel states, “Emblematic of existing societal values and practices within the profession, medical schools, residency programs, hospital staffs and professional societies largely excluded African Americans. For more than 100 years, many medical associations, including the AMA, actively reinforced or passively accepted this exclusion. Still, throughout this history, vocal groups of physicians – black and white, and within and outside these associations – challenged segregation and racism.” NMA President Nelson Adams, M.D., said, "We commend the AMA for taking this courageous step and coming to grips with a litany of discriminatory practices that have had a devastating effect on the health of African Americans.”
Senate Passes Medicare Bill - July 2008 The Senate today passed H.R. 6331, legislation that would prevent a July 1 Medicare physician payment cut from taking effect. The bill received a vote of 69-30, exceeding the 60 affirmative votes needed to invoke cloture and begin debate on the bill, which overwhelmingly passed the House last month. The bill subsequently passed on a voice vote. Sponsored by Reps. Charles Rangel (D-NY) and John Dingell (D-MI), H.R. 6331 would freeze physician payments for 2008 and provide a 1.1% increase for physicians in 2009. It also contains several rural hospital provisions and would delay for 18 months the competitive bidding program for Durable Medical Equipment (DMEPOS). The Senate last month failed to invoke cloture on both this bill and similar legislation (S. 3101) sponsored by Senate Finance Committee Chairman Max Baucus (D-MT). The bill will now be sent to President Bush for signature, although he has said he will veto the measure due to the provisions that would cut payments to Medicare Advantage plans.
CMS Rolls Out Medical Necessity Review Plan for Hospitals - July 2008 The Centers for Medicare & Medicaid Services today released its plan to transition responsibility for measuring and preventing improper payments to inpatient and long-term care hospitals from quality improvement organizations to other Medicare contractors. According to the plan, fiscal intermediaries and Medicare administrative contractors this summer will begin performing medical review of inpatient hospital and LTCH claims, on either a pre- or post-payment basis, to ensure that they are for covered, correctly coded, and reasonable and necessary services, and will adjust claims as appropriate. In addition, comprehensive error rate testing contractors since April have been able to perform post-payment reviews to measure inpatient hospital payment error rates. Quality Improvement Organizations will continue to perform quality oversight in all Medicare fee-for-service settings; provider-requested, higher-weighted, diagnosis-related group reviews; EMTALA reviews; provider education on quality of care issues; and expedited determinations. Don May, AHA vice president for policy, said, “The AHA is concerned with how these changes will be transitioned and we will meet with CMS to discuss implementation moving forward.”
Moratorium on Laboratory Billing Policy Expires - July 2008 A moratorium allowing independent laboratories to continue billing Medicare for the technical component of physician pathology services provided to hospital patients expired on June 30. Thus, hospitals must bill Medicare directly for the technical component of physician pathology services provided on or after July 1 by an independent lab to hospital outpatients. For inpatients, CMS considers the payment for the technical component to be included in the hospital diagnosis-related group. Hospitals would have to make arrangements to pay labs for their services after June 30. The House-passed Medicare bill (H.R. 6331), which could go to the Senate floor as soon as tomorrow, would extend the earlier moratorium, as would Medicare bills introduced by Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA).
OIG Issues Advisory Opinion on Patient Gift Card - July 2008 A health system’s proposal to provide $10 gift cards to patients whose service expectations were not met would not constitute prohibited remuneration, the Department of Health and Human Services’ Office of Inspector General concluded in an advisory opinion released yesterday. The health system proposed to offer patients who experience service shortfalls, such as a 30-minute delay in service, gift cards for certain local vendors through a gift certificate service. The cards would not be redeemable for cash or health care items or services, and the health system would track the cards to ensure the same patient did not receive multiple cards totaling more than $50 in value in one year.
CMS Extends Deadline for Submitting HCAHPS Data - July 2008 The Centers for Medicare & Medicaid Services has extended the deadline for submitting HCAHPS data to the hospital quality reporting initiative for first-quarter 2008. Hospitals can submit data for Jan. 1 through March 31 discharges to the My QualityNet Web site through 11:59 p.m. Central Standard Time on July 16. They should review their submission or feedback reports and resolve any submission issues prior to the deadline. The QualityNet site was inoperable for several weeks in June while the contractor performed emergency maintenance.
CMS Releases Proposed 2009 Outpatient/ASC Rule - July 2008 The Centers for Medicare & Medicaid Services today released a proposed rule updating Medicare payment rates for hospital outpatient and ambulatory surgery center services for calendar year 2009. According to the rule, CMS would continue to transition to the new ASC payment rates, with ASC services paid at a 50/50 blend of the 2007 ASC payment and the 2009 ASC payment, which are 65% of the hospital outpatient rate. Hospitals reporting seven outpatient quality measures in 2009 would receive a 3.0% inflation update, while eligible hospitals not submitting data would receive a 1.0% update. The proposed rule outlines the process for validating hospitals’ quality data; proposes adding four new imaging efficiency quality measures for public reporting in order to receive a full update in CY 2010; and seeks comment on 18 other quality measures for potential inclusion at a future date. It also would alter how CMS pays for imaging services when multiple services are provided in one session, by creating a single payment for certain multiple imaging services such as ultrasound, computed tomography and magnetic resonance imaging. The rule also changes the way partial hospitalization services are paid, reduces payments for separately payable drugs, and proposes changes to the hospital Medicare cost report for drugs and biologicals. The rule will appear in the July 18 Federal Register, with comments accepted until Sept. 2. AHA staff is analyzing the rule, and a Special Bulletin with further details will be sent to AHA members on Monday.
Study Examines Parity in State Health Coverage Initiatives - July 2008 While more than one in four uninsured U.S. adults has a mental illness or substance-use disorder, many state initiatives to cover the uninsured neglect those conditions, according to a new study by the National Alliance on Mental Illness and National Council for Community Behavioral Healthcare. Eleven of the 18 states examined included parity in mental health coverage in at least one program or proposal for the uninsured, while only five included parity for substance-use disorders, the study found. Among other concerns, few states included mental illness and substance-use disorders in their wellness and chronic disease management programs, the groups said.
Joint Commission Reorganizes Hospital Standards for 2009 - June 2008 The Joint Commission has reorganized its hospital standards and elements of performance for 2009, and for the first time has made them available online. The reorganization added no new requirements, but clarified the language of existing requirements, some of which were deleted, consolidated or separated. The Joint Commission also renumbered and reordered the standards to allow electronic sorting and the addition of new requirements in the future. The Joint Commission plans an extensive outreach effort to help organizations understand the changes before the standards take effect on Jan. 1.
HRSA Issues Health Center Report, Locator Tool - July 2008 Federally funded health centers provided a medical home to more than 16 million patients in 2007 at an average cost per patient of $559, according to a new report from the Health Resources and Services Administration. About 6.2 million of those patients lacked health insurance, up from 4 million in 2001. More than 1,000 federally funded health centers deliver services at 6,000 sites in U.S. states and territories, about half in rural and half in urban areas. These health centers employ 8,000 physicians and more than 4,700 nurse practitioners, physician assistants and certified nurse mid-wives. Annual funding for federal health center programs nearly doubled from 2000 to 2007 to more than $2 billion. Consumers can locate the nearest federally funded health center using a new online tool.
Survey: Large Employers Offering Wellness Programs, Incentives - July 2008 Seventy-seven percent of large employers offer health and wellness programs, and 48% offer disease management programs, according to a new survey by the ERISA Industry Council and National Association of Manufacturers. Seven in 10 respondents with health and wellness programs offer incentives for employees to participate, with the average incentive valued at just under $200. Gift cards were the most popular incentive, followed by premium reductions, cash, merchandise and health account contributions. Many large employers without health and wellness programs planned to add them in the next year.
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