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January 27, 2015

Posts in "Medicare"

January 6, 2015

Study: Medicare Preventive Care Visits Spike

A major Medicare element of the Affordable Care Act was a requirement to fully cover annual preventive care visits. Before 2005, Medicare did not cover any preventive care visits, except for mammography and Pap smears. In 2011, the health law added annual wellness visit coverage offering a range of preventive care services at no cost to the beneficiary.

A research study released this week in HealthAffairs (view abstract) indicates that the requirement appears to be enticing wellness consultations. Preventive care visits in the test group increased from 1.4 percent before the health law wellness visit addition to 27.5 percent afterwards. Patients on Medicare’s standard fee-for-service plans have flocked toward preventive care services. However, the study notes that fee-for-service preventive care visits are still lower than private and Medicare HMO plans.

See also: Preventive Health Services Recommendations for Children

By Paul Jenks Posted at 9:22 a.m.
Insurance, Medicare

January 5, 2015

Incoming Congress: Keep an Eye on Budget Panels and House Ways and Means Committee

The 114th Congress convenes this week and congressional Republicans will assemble majorities in both the House and Senate. A top early priority is action on extending relief from a planned Medicare physician payment cut, which is set to begin on April 1. Action on a payment adjustment could be tied to an increase in the federal debt limit, which will begin to press upon lawmakers starting on March 15.

Also, several new committee chiefs will get the first crack at determining the fate of major health care legislation and changes to the 2010 Affordable Care Act.  Rep. Tom Price. a Georgia physician and health law foe, is likely to become the next chairman of the House Budget Committee, which holds the keys to initial planning on any changes in the health care overhaul law. Wyoming Sen. Michael B. Enzi, another health law opponent, is poised to take the helm of the Senate budget panel. Separately, the House Ways and Means Committee will be led by Wisconsin Republican Rep. Paul D. Ryan, who take the lead in any possible health care entitlement program changes.

Ryan, the previous chief of the House Budget Committee, has led a long-running campaign to overhaul the Medicare program. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.

The 114th: CQ Roll Call’s Guide to the New Congress

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December 22, 2014

Ahead for the New Congress: Physician Payment Adjustments

Congress will return in January with some new faces and a newly-minted Republican Senate majority (check out Roll Call’s guide to the 114th Congress) but lawmakers will face decisions on a an old topic. The first major item on the  health care legislative agenda is action on adjusting Medicare and Medicaid payments to physicians, which expire on Dec. 31 for special Medicaid reimbursement and March 31 for Medicare payments.

The primary roadblock for any physician payment adjustment is finding sufficient offsetting spending reductions in other programs (or tax increases) to pay for halting the payment cuts. The search for fiscal offsets has bedeviled action on physician payment measures for years and is shadowed by more troublesome decisions on federal deficit spending reduction. Health care and entitlement program spending, which accounts for the bulk of all federal spending, lies at the center of any effort to reduce annual spending deficits.

Note: Healthopolis will resume regular publication on Jan. 5. 


December 4, 2014

CMS Clamps Down on Delinquent Medicare Providers

Medicare health service providers have to navigate a complex payment system, which is frequently adjusted to meet federal fiscal needs. On Wednesday, the Centers for Medicare and Medicaid Services added additional requirements on provider enrollment.  New regulations were unveiled Wednesday culling health care providers that have unpaid debts, employee felonies and abusive billing practices. The new rules, which are set for official publication on Friday, seek to save more than $327 million each year.

The rules prevent organizations from enrolling as a Medicare provider if they already have unpaid Medicare debts, thus preventing a group from withdrawing from the program then re-entering the program as a new business.

Congress also has mulled the dunning of Medicare providers for delinquent income taxes. On several occasions this year and in 2012, lawmakers tried to increase the tax levy authority to seize Medicare payments of tax delinquent providers and suppliers. However, the tax seizure idea offered by lawmakers was not a part of an effort to cull bad Medicare providers but rather a means to fix highway trust funding.


By Paul Jenks Posted at 10:44 a.m.

December 3, 2014

Looking for Fiscal Offsets? Look Toward Medicare

Adjustments to health care spending, particularly regarding Medicare benefits and payments, is often central to soothing any fiscal concerns about almost any new program or renewal bill in Congress. Today, the House plans to vote on a bill that creates new tax-exempt accounts for individuals with disabilities.

Of course, there is a fiscal cost to offering the new accounts and the last-minute substitute version of the measure adds several of Medicare adjustments to pay for bulk of the cost of the tax exemption. The most visible offset item is a ban on Medicare payments for vacuum systems for the treatment of erectile dysfunction (penis pumps). Ending the pump payments is coordinated with any changes to existing restrictions on Medicare Part D payments for erectile dysfunction drugs.

The measure also extends for an additional year, through 2024, the current Medicare policy on separate payments for oral drugs used to treat end-stage renal disease. The provision is a perennial offset element and 2023 payments were extended in an earlier Medicare physician payment bill. Additionally, the bill seeks to expedite plans to begin adjusting Medicare payment rates for misvalued physicians’ services. The total savings over 10 years for just these three Medicare provisions exceeds $1.2 billion, which illustrates why Medicare is a popular place to look for fiscal savings.


November 19, 2014

The Other Physician Payment Extension Deadline

A seemingly permanent fixture on the congressional agenda is ongoing action to thwart cuts to Medicare payments to physicians and other health care providers. Congress is always focused on the annual effort to halt substantial Medicare payment cuts to doctors. However, there is another looming deadline on enhanced Medicaid payments to primary care physicians.

The Affordable Care Act included a provision that allowed for increased Medicaid payments to primary care physicians at 100 percent parity with Medicare payment rates. The revised payment program began in 2013 but the enhanced payment term was limited to two years and is now set to expire. Unlike the Medicare physician payment deadline, which expires on March 31, 2015, the Medicaid parity payment adjustment expires on Dec. 31, 2014.

A prepared Senate bill (S 2694) offers a parity payment extension for two more years and adds payments to other physician groups. The White House’s initial request for a stopgap-spending bill in September also included a suggestion for an extension of Medicaid payments. Congress now is scrambling to craft the elements of a final year-end omnibus spending bill or another stopgap funding resolution. If the Medicaid payment parity adjustment expires, physician groups likely will to press for retroactive adjustments in next year’s spending bills.



November 18, 2014

Mulling the Cost of a Physician Payment Fix

Every year for nearly two decades Congress has adjusted the Medicare physician payment formula to avoid payment cuts. The annual – and sometimes monthly – ‘doc fix’ adjustment is the result of a set payment formula that has regularly forced reductions in physician payments.

Ideally, lawmakers and physician groups have long sought to eliminate the formula, instead of haggling over annual adjustments. However the cost of a complete repeal of the formula is an expensive proposition. The current stopgap fix for physician payments ends on March 31 and CQ Roll Call’s Melissa Attias on Monday reported (subscription) on some Republican interest to eliminate the vexing payment formula as early as this year. However, any repeal effort must overcome demands for fiscal offsets to pay for either a complete repeal or another annual extension of relief from a payment cut. The Congressional Budget Office on Friday conveniently reminded lawmakers of the cost options in an update of its analysis of the budgetary impact of various physician payment adjustment alternatives.


November 14, 2014

CMS Tests Prior Approval for Repetitive Ambulance Services

The Centers for Medicare and Medicaid Services today announced a trial program requiring Medicare prior-authorization approval for persons seeking repetitive, non-emergency ambulance transportation. The prior authorization trial, which begins on Dec. 1, is limited to New Jersey, Pennsylvania and South Carolina.

CMS records the three states as having the highest rates improper payments fraud. The issue has been a festering for many years as all ambulance transport requests have been increasing. A 2012 GAO report noted an increasing demand for basic life support non-emergency transportation but also cited the possibility that local governments are more inclined to bill Medicare for services that used to be provided free of charge. Additionally, Department of Health and Human Services auditors estimated as long ago as 2006 a 25 percent improper billing rate for non-emergency transportation.



By Paul Jenks Posted at 11:38 a.m.

October 23, 2014

Health Programs Factor in Upcoming House Committee Leadership Changes

The focus on upcoming November congressional elections understandably centers on possible election results and which party will control the Senate. However, the election of a new Congress, which convenes in January, also starts the process for reconfiguring the leadership of pivotal House committees. Roll Call’s Emma Dumain and Matt Fuller today examine possible GOP leadership changes in 11 different committees.

Health care program funding authority, particularly for the Medicare program, falls under the jurisdiction of the House Ways and Means Committee. The committee’s current chairman, Michigan Republican Rep. Dave Camp is retiring and Wisconsin Republican Rep. Paul D. Ryan has the inside track — but has some competition — to take over the gavel of the powerful tax committee.

Ryan has led a long-running campaign to overhaul the Medicare program as the chief of the House Budget Committee. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.  At the helm of the Ways and Means Committee, Ryan would have the opportunity to craft a Medicare overhaul measure instead of offering budgetary suggestions.

If Ryan departs from the budget panel, the heir apparent is the committee’s current Vice Chairman, Rep. Tom Price, a conservative physician from Georgia. Price is a staunch opponent of the 2010 health care overhaul law and has authored his own proposal on overhauling health insurance coverage options. Price’s plan relies on offering tax breaks to give people the means to buy health insurance instead of the current health insurance exchange plan subsidies.

October 9, 2014

HHS Auditor: Rural Hospital Patients Pay Higher Coinsurance Rates

Federal Medicare payments are higher for more than 1,300 facilities that meet the criteria as a critical access hospital (CAH). However, federal auditors in a report issued on Wednesday concluded that differences in payment levels for the select group of hospitals serving rural areas compared to other Medicare hospital payment rates means that Medicare beneficiaries at CAH hospitals pay a higher percentage of the costs in coinsurance for outpatient services.

The coinsurance charge for some outpatient services is 20 percent of the hospital charge submitted to Medicare but Medicare allows a higher rate for CAH hospitals, meaning the coinsurance amount is also higher. The Department of Health and Human Services Inspector General recommends congressional action to reduce the percentage of costs that Medicare beneficiaries pay in coinsurance or modify how coinsurance is calculated.

By Paul Jenks Posted at 11:23 a.m.

CBO: Annual Deficit is Lower But Health Program Spending Is Up

The federal government ended the 2014 fiscal year with an estimated $486 billion annual deficit, which is the lowest deficit level since 2008. The Congressional Budget Office monthly budget report pegs the lower deficit estimate largely on increased receipts from taxpayers.

However, overall federal spending — measured as outlays — increased and Medicaid and health insurance subsidy payments increased by 19 percent over 2013 levels. The CBO identifies the 2014 start of subsidized insurance plans and expanded state Medicaid coverage as a main reason for overall spending increase. Federal outlays on Medicaid and insurance premium subsidies increased in 2014 by $49 billion.

In September, the final month of the fiscal year, defense spending and reduced unemployment benefit outlays were down by $2 billion but spending for Medicaid increased 10 percent and Medicare increased 5 percent.





September 23, 2014

Pressure Mounts for Medicaid and Medicare Physician Payment Fixes

Doctors have long-held a prominent lobbying role in Congress. Most of the focus of recent efforts by physician groups revolves around pressing to continue temporary adjustments to several Medicare and Medicaid payment formulas.

In November, members of a  physician group are planning visits to lawmakers on Capitol Hill to urge an extension — beyond the scheduled year-end expiration — of a temporary Medicaid payment boost for primary care doctors. The payment increase was an attempt to reduce the gap between Medicaid and Medicare payment levels. The administration, earlier this month in its stopgap spending bill request, urged lawmakers to extend the primary care payments. But the adopted continuing resolution ignored the White House suggestion. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reports on plans for the physician visits organized by the American Congress of Obstetricians and Gynecologists.

Also looming on the congressional agenda is the renewal of extended relief from planned cuts slated for next year to the broader Medicare physician payment formula. Congress has acted to thwart a scheduled physician payment cut each year for more than a decade. CQ Roll Call’s Melissa Attias reports that some lawmakers hope to permanently fix the payment formula during this year’s lame duck session. However, a permanent fix has long been a bipartisan objective but has been thwarted by disagreement on how to pay for the payment formula adjustment.

September 19, 2014

Commission Examines Short Hospital Stay Payments

Congress needs lots of help in deciphering and analyzing Medicare provider payment policies and created an expert group – the Medicare Payment Advisory Commission – to advise on payment policy changes. A current major topic on Medicare payments relates to how hospitals are paid based upon the length of a hospital stay.

CQ HealthBeat’s (@CQHealthTweet) John Reichard reported this week that the Medicare payment commission is currently examining Medicare payment policy for single-day hospital stays.

Short inpatient stays, particularly for a single day, are one of the biggest money-makers for hospitals. Medicare currently pays hospitals a fixed sum for a particular diagnosis based on a calculation of costs that typically assumes a longer stay. However, Medicare auditors have targeted single-day stays in an effort to stamp out improper billing practices and the majority of Medicare claim denials in 2012 were for one-day stays.

Hospitals have taken steps to cut the risk of having their billings challenged and are increasingly classifying short-stay patients as being under “observational” status, which pays at lower outpatient rates.  However, patients listed in observational status must pay a 20 percent copay for outpatient treatment while they pay a fixed deductible for inpatient care of $1,200.


September 8, 2014

Green Acres’ Mr. Haney Weighs In on Medicare

Commentary on the Affordable Care Act is ubiquitous on thousands of blogs and a variety of cable networks. However, the media avenues for commentary and opinions on the first major health insurance coverage expansion program – Medicare – were limited when the Medicare program began in the 1960s. Printed newspapers (including Congressional Quarterly and Roll Call) and three broadcast television networks were the primary sources to opine about the program. An episode of the quaint rural situation comedy, Green Acres, which aired on CBS from 1965-1971 weighed in on the wonders of Medicare, in a backhanded way. The occasional protagonist character, Mr. Haney (Pat Buttram) lectured the show’s stars, the rural transplants played by Eddie Albert and Eva Gabor, about all the “free medical care” offered through Medicare.

View the Green Acres clip


Roll Call Election Map: Race Ratings for Every Seat

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August 14, 2014

Medicare Reward and Ambulance Payment Rules Await White House Approval

The White House Office of Management and Budget  is the last stop prior to final approval of most agency rule proposals. This week, the Centers for Medicare and Medicaid Services sent to OMB a final rule revising several Medicare provider enrollment conditions, designed to block fraudulent suppliers. The proposal also adjusts an incentive reward for reporting potential fraudulent providers. Initial proposed rules, unveiled in 2013, suggested an increase of the reward from 10 percent of over-payments recovered to 15 percent.

Also, the original draft included a provision limiting the ability of an ambulance service to “back bill” for transportation services provided prior to a new Medicare provider enrollment application. However, ambulance providers commented that back billing is sometimes necessary to provide emergency coverage in a service region following the abrupt withdrawal of another ambulance service, when there isn’t enough time to process a new  application.

The timetable for White House handling of rules and the final components of the new regulations can vary. Approval can be processed within days of receipt or a proposal can linger at OMB for months due to internal discussion and debate.

By Paul Jenks Posted at 12:31 p.m.

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