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Healthcare March Madness

March 18, 2015


March Madness is a nickname forever fixed to the single elimination National Collegiate Athletic Association (NCAA) Division I college basketball tournament that occurs each spring in the United States.  As millions of Americans scramble to fill out their March Madness brackets, those of us in healthcare get to experience our own version.  With another deadline fast approaching for eligible individuals to enroll in the Affordable Care Act (ACA), the White House’s March Madness campaign is a chance to get the attention of young people, especially young men to sign up for healthcare before the March 31 deadline.  Anyone in need of affordable coverage should head over to HealthCare.gov and #GetCoveredNow.  Anyone that is already covered can help spread the word by voting for your favorite reason to get covered.  While you are at you can check out President’s Obama bracket picks at https://www.whitehouse.gov/acabracket.


ICD-10 Transition Aided by Computer Assisted Coding

March 11, 2015


Medical coding is a key step in the revenue cycle billing process. When patients receive health care services in a physician’s office, hospital or outpatient facility, each service provided must be documented in the form of a medical record.  The role of a medical coder is to abstract the information from the medical record, assign the appropriate ICD-91 Diagnosis and ICD-9 and/or CPT procedure codes and create a claim that is billed to a commercial payer, Medicare, Medicaid or directly to the patient.


CMS Delays Final Rule on Medicare Overpayments yet Providers are Still Obligated to Make Timely Refunds

March 4, 2015


The Centers for Medicare and Medicaid Services (CMS) has delayed the publishing of its final rule on procedures and policies for reporting and returning Medicare overpayments for at least another year, according to a notice published February 13 in theFederal Register.  “Based on both public comments received and internal stakeholder feedback, we have determined that there are significant policy and operational issues that need to be resolved in order to address all of the issues raised by comments to the proposed rule and to ensure appropriate coordination with other government agencies,” CMS officials wrote.


Hospice Claims Under Inspection

February 25, 2015


Medicare hospice care is intended to help terminally ill beneficiaries continue life with minimal disruption and to support families and caregivers.  Care may be provided in various settings, including a private home or other places of residence, such as an assisted living facility (ALF).  This care is palliative, rather than curative.  It includes, among other things, nursing care, medical social services, hospice aide services, medical supplies (including drugs and biologicals) and physician services.  The beneficiary waives all rights to Medicare payment for services related to the curative treatment of the terminal condition or related conditions but retains rights to Medicare payment for services to treat conditions unrelated to the terminal illness.


Since 1990 the Medicare Program has been Designated as a “High-Risk”

February 18, 2015


The Government Accountability Office (GAO) has released its latest update to its “High-Risk Series” reports, which again lists Medicare as a high-risk program, in part because of the program’s substantial size and scope, and its wide-ranging effects on beneficiaries, the health care industry and the U.S. economy.  In fiscal year 2014, Medicare outlays will total more than is projected to be spent on defense ($594 billion) and almost double federal spending on Medicaid ($305 billion).  Medicare spending will account for nearly 17 percent of the approximately $3.5 trillion in federal outlays.  The report recommends continual attention to the following five areas.


The President’s Precision Medicine Initiative

February 11, 2015


President Obama stated during his 2015 State of the Union address that he wanted the United States to lead a new era of medicine—an era that delivers the right treatment at the right time.  The President’s initiative was labeled as “precision” or personalized medicine.  Precision medicine is a term for tailoring treatments to an individual’s genetic makeup, microbiome and other factors.  In a call with the press in late January, Jo Handelsman, Associate Director for Science in the White House Office of Science and Technology Policy called precision medicine as “a game changer” that “holds the potential to revolutionize the way we approach health in this country and ultimately around the world.”


HHS Scores Second Win with Primary Care Quality and Value Initiatives

February 4, 2015


Last week we reviewed Health and Human Services (HHS) Secretary Sylvia M. Burwell’s January 26, 2015 announcement on specific goals and a timeline for shifting Medicare reimbursements from the traditional fee-for-service (FFS) model to a quality or value-based model.  The  HHS team is optimistic in achieving its goals, noting in its press release that it has “already seen promising results on cost savings with alternative payment models” through a combined total program savings of $417 million to Medicare due to existing ACO programs.  Moreover, it “expects these models to continue the unprecedented slowdown in health care spending.”1


The State of the Union and Healthcare

January 28, 2015


Like many with careers in healthcare delivery or administration, we anxiously listened to each word of President Obama's 2015 State of the Union address to see what the White House agenda may be for the remainder of his Presidency.  While guarantees of sick days, paid maternity leave, along with the successful battle to control Ebola, and find cures to other deadly diseases, were mentioned, the President’s address seemed light on healthcare, especially considering the turmoil over the past year with the Affordable Care Act (ACA).


The Growth of Telehealth/Telemedicine Spawns New Regulations

January 21, 2015


Many people, even in the healthcare industry, tend to speak about telehealth and telemedicine as if they are the same thing.  Actually, outside of the general notion that they involve transmitting health-related information, they are different concepts.  Currently, there is no one best definition of these two terms, resulting in some crossover and variances in regulations between federal and state governments.


Medicare Payment Advisory Commission Begins Work on Next Year’s Recommendations

January 14, 2015


The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program.  The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.


A New Year, A New Congress: Will it Make a Difference Regarding Healthcare Legislation?

January 7, 2015


Thirteen new senators and 58 new House members were sworn in as the 114th Congress opened with its traditional pomp on Tuesday, January 6, 2014.  With Republicans winning control of the Senate in the November election, their party now has command of the House and Senate for the first time in eight years and will control the legislative branch during the final two years of President Obama’s term and the run-up to the 2016 elections.  Most Americans are likely wondering if it will make a difference.  The 6.7 million newly insured under the Affordable Care Act (ACA) might be asking, so what now?


Sony’s Security Shockwave: Healthcare Providers Need to Finally Pay Attention to HIPAA Security

December 31, 2014


Last month, a previously unknown group that calls itself the Guardians of Peace (GoP) hacked Sony Pictures Entertainment (SPE). The group has since posted online financial figures and tens of thousands of emails between top Sony executives. Some of the emails deal with costs for upcoming films, casting decisions, release schedules through 2018 and corporate royalties from iTunes, Spotify and Pandora. There has been speculation that North Korea organized or paid for the Sony hack. Whether the hackers were or were not agents of the North Korean government does not change the fact that every government, corporation and organization, including healthcare information systems, has been or may be hacked by both foreign and domestic attacks.


New Rules to Protect Against Fraud and Abuse

December 10, 2014


The Centers for Medicare and Medicaid Services (CMS) has announced new rules that strengthen oversight of Medicare providers and protect taxpayer dollars against abusive practices.  The rules are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing and implement other provisions.


Lame Duck Congress: Will They Take Action on Pending Healthcare Bills?

December 3, 2014


The short answer is unlikely. Based on the Congressional calendar, adjournment is set for the holidays as of December 12. The overarching priority between now and the holiday recess is a bill to keep the government running to avoid a shutdown. The appropriations committees in the House and Senate, which allocate the funding, said they would have a $1 trillion spending bill ready by next week. Other top priorities are to reauthorize funding and training of Syrian moderates to strike at ISIS militants in Iraq and Syria and continue tax breaks set to expire. For a Congress that has a bit of controversy between the White House and its members, not to mention party line politics, this is an ambitious agenda to accomplish in the span of two weeks. The unfinished business, some of it untouched for two years, needs to be completed before Congress takes off for the holiday and its new session begins in January.


Thanksgiving: A Time to be Thankful for The American Healthcare System

November 26, 2014


It is easy to complain about what is wrong with Healthcare in America and what keeps healthcare executives up at night, e.g. lower reimbursement, meaningful use, overall too many changes at the same time.  On the eve of a truly great American holiday, Thanksgiving Day, it is fitting to take a look at five trends in healthcare that all Americans can appreciate.  They are:


Hospital Outpatient Prospective Payment System (OPPS) 2015 Final Rule

November 19, 2014


The Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule with comment period [CMS-1613-FC] on October 31, 2014.  The final rule appeared in the November 10, 2014 Federal Register.  The provisions in the rule will generally take effect on January 1, 2015.  The public comment period will close on December 30, 2014.  The major changes included in CMS' CY 2015 Hospital OPPS Final Rule are:


CMS Releases Final Rules on Medicare Physician Payments

November 12, 2014


Last Friday the Centers for Medicare & Medicaid Services (CMS) released final rules that implemented changes and updates to payments made under the Medicare Physician Fee Schedule (PFS).  Last year the Protecting Access to Medicare Act of 2014 prevented significant reductions to physician payment through the sustainable growth rate (SGR) formula, but this policy is in effect only until March 31, 2015.  The new Congress will need to address physician payment early next year to prevent the significant reductions to payments that are scheduled to start in April 2015.


The 2015 Office of Inspector General Work Plan

November 5, 2014


Last Friday, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its 2015 Work Plan which summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.


Panic, Pandemic and Protected Health Information

October 29, 2014


Do you remember H1N1?  Can you recall the panic across the United States (US) when AIDS/HIV first hit the news?  Now we find our country in a panic over Ebola—a disease that has been contained to impoverished countries with little to no healthcare—until September 28th when the Centers for Disease Control and Prevention (CDC) confirmed, through laboratory tests, the first case of Ebola to be diagnosed in the US.1 There is much that we are learning daily about Ebola, how to treat it and how to protect healthcare workers against exposure.  This disease is a frightening situation to nurses, other healthcare workers and every day citizens.  We have seen cruise ships and schools impacted and many people fear that their community may be next.  Some believe it will get worse in the US before it gets better.  Others feel we have little reason to panic.


Electronic Health Records and Meaningful Use Challenges

October 22, 2014


The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services (HHS) 2014 Report to Congress found that electronic health record (EHR) adoption among hospitals and physicians has grown substantially since the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH).  In 2013, 59 percent of hospitals and 48 percent of physicians had at least a basic EHR system, respective increases of 47 percentage points and 26 percentage points since 2009, the year the HITECH Act was signed into law.  Moreover, there is widespread participation among eligible hospitals and professionals in the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Programs.  As of June 2014, 75 percent (403,000+) of the nation’s eligible professionals and 92 percent (4,500+) of eligible hospitals and Critical Access Hospitals (CAHs) had received incentive payments.


Reality TV Show: Pioneer Accountable Care Organizations

October 15, 2014


Fall means a new batch of reality television.  We can watch Real Housewives go bad, designers throwing tantrums while vying for a spot at Fashion Week and even everyday folks seeking Utopia.  Critics often cite the best reality shows to watch are those that combine common sense, creativity and the survival adventure.  After reviewing the Centers for Medicare & Medicaid Services (CMS) financial data released last Thursday on the trail-blazed Pioneer accountable care organizations (ACOs), it is amazing that the networks and cable executive producers missed out on this real life financial drama.  With healthcare reform a popular topic, the bumpy road the original 32 Pioneer ACOs have experienced would have served as some exciting trials and tribulations as CMS officials, hospital executives, physicians and patients tried to navigate better healthcare quality while achieving cost savings.


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