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Congress Take Step Toward Site-Neutral Medicare Payments in Bipartisan Budget Act of 2015 Print E-mail
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Thursday, 29 October 2015 00:00

On October 28, 2015, the U.S. House of Representatives approved legislation that, if enacted, would, among other things, substantially alter how and how much Medicare pays for outpatient services furnished by hospitals. The legislation, known as the Bipartisan Budget Act of 2015, principally reflects and implements a two-year federal budget and debt limit compromise negotiated between President Obama and congressional Republicans that diminishes many of the harshest spending reductions wrought by sequestration, and avoids a potential default on U.S. debt obligations. Nonetheless, the legislation is drawing heightened scrutiny by, and concern within, the health care community- not because of the central purposes of the bill, but rather because of a handful of Medicare and Medicaid related provisions also included in the legislation.
Of perhaps greatest significance to the health care community is a provision (Section 603) that would provide that effective January 1, 2017, Medicare payments for most items and services furnished at an off-campus department of a hospital that was not billing as a hospital service prior to the date of enactment would be made under the applicable non-hospital payment system. This "site neutrality" provision begins to address concerns raised by certain policymakers in recent years that Medicare should not..
Last Updated on Friday, 13 November 2015 16:28
OIG Calls for CMS to Reform Payment for Skilled Nursing Facility Services Print E-mail
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Wednesday, 07 October 2015 15:55

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report on September 30, 2015, that calls for the Centers for Medicare and Medicaid Services (CMS) to reform payment for skilled nursing facility (SNF) services. The OIG focused on billing for therapy (e.g., speech, occupational, physical) as a driver increasing SNF revenue and noted that SNFs' margin on Medicare reimbursement for therapy was 29 percent. 

Medicare pays SNFs a daily rate for therapy that is primarily based on the level of therapy provided to the beneficiary. The OIG's review of therapy billings indicated that a disproportionate number of beneficiaries received 720 minutes of therapy during the relevant seven-day assessment period-exactly the number of minutes required for "ultra-high" categorization, which results in a higher level of resource utilization group, which in turn results in higher reimbursement.

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CMS to Test Value-Based Insurance Design in Medicare Advantage Print E-mail
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Friday, 18 September 2015 16:33

On September 1, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage Value-Based Insurance Design Model (Model). Medicare Advantage (MA) Organizations operating in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee may apply to use reduced cost-sharing and/or supplemental benefits to encourage enrollees with one or more of seven targeted chronic conditions to consume higher value health care services. Specifically, CMS will allow participating MA Organizations to propose specific interventions for enrollees in one or more CMS-identified chronic disease categories that involve (i) reduced cost sharing for high value services, (ii) reduced cost sharing for high value providers, (iii) reduced cost sharing for enrollees participating in disease management or related programs or (iv) coverage of additional supplemental benefits (collectively,VBID Interventions). While CMS attempts to provide a pathway forward through the MA regulations, the Model presents certain legal risks about which MA Organizations should be aware.

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Last Updated on Friday, 02 October 2015 12:02
Shifting Hospice Reimbursement - Moving in the Direction of Aligning Payment with Resource Concentration Print E-mail
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Friday, 11 September 2015 14:55

The Centers for Medicare and Medicaid Services (CMS) published its update to the home health prospective payment system for fiscal year 2016 in the August 6, 2015, Federal Register (the Final Rule). The Final Rule announces an overall 1.1 percent increase in hospice payments for FY 2016, but also makes significant changes to the structure of hospice payments for certain patients to reflect the higher costs borne by providers at different stages of the hospice benefit. These changes address some, but not all, of the challenges associated with applying a per diem rate to a benefit with highly variable costs over time, given the unique circumstances of each beneficiary's end-of of-life needs. Implementation of these new payment structures will have a financial and operational impact on hospice providers, with potential implications for referral patterns, billing systems, staffing models and clinical care guidelines. This significant change to one of the first bundled payment systems implemented by CMS may also set a precedent for service bundling in other areas of health care.

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Last Updated on Friday, 18 September 2015 16:47
Medicare ACOs saved $411M in 2014, but few earned bonuses Print E-mail
Written by Ilene MacDonald | Fierce Healthcare   
Friday, 28 August 2015 17:18

Medicare accountable care organizations generated $411 million in total savings in 2014, but few of the Pioneer and Medicare Shared Savings Program (MSSP) ACOs qualified for bonuses in the second year of the program, according to the latest data from the Centers for Medicare & Medicaid Services (CMS).

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