Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
October 22, 2014

Posts in "Medicare"

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


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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.

August 12, 2014

Anti-Fraud Bill Presses CMS to Nix Social Security Numbers on Medicare Cards

Medicare identification cards would no longer display beneficiaries’ Social Security numbers under a new bill outlined recently by the chairman of the House Ways and Means Subcommittee on Health. Rep. Kevin Brady, R-Texas, released the draft text of a measure that compiles a wide range of suggestions to thwart Medicare and Medicaid payment fraud and abuse. The proposals– collected from a bipartisan suggestions offered by committee members — range from halting payments for health services provided to deceased beneficiaries to enhanced fraud abuse monitoring of various specific provider payments, such as those for medical equipment, vacuum erection systems and ambulance services.

The aim of ending the printing of Social Security numbers on Medicare cards is to protect against possible fraud against Medicare beneficiaries, rather than to save the program’s money. The Medicare card is one of the few remaining federal documents that still display the full Social Security number, opening up the possibility for identity theft if the card is lost or stolen.

Eliminating Social Security numbers on the card is a long-running bipartisan congressional objective that has not been taken up by the Centers for Medicare and Medicaid Services. HealthBeat’s John Reichard reported in April on questions about the ID card posed to CMS official at a panel hearing on Medicare fraud. The Medicare agency insists that it lacks the resources to make the change.

The Government Accountability Office in 2012 reviewed several options offered to CMS to change the Medicare card. The suggestions included replacing the number, only partially displaying it, or denoting it in a machine readable bar code.


July 31, 2014

Medicare Payment Quirk Grabs Senate Panel’s Attention

Senators on Wednesday mulled the impact of a restriction in Medicare payment policies that has riled both hospitals and patients. When a Medicare patient stays in a hospital under “observation status” the person does not qualify for certain Medicare coverage in a subsequent stay in a nursing home or rehabilitation facility — and may end up paying more in co-payments and drug costs.

Full story

By Paul Jenks Posted at 10:10 a.m.
Hospitals, Medicare

July 30, 2014

Powered Wheelchairs: CMS Expands Payment Scrutiny

A trial program that requires prior-authorization before payment for power mobility devices, or powered wheelchairs, will be expanded by the Centers for Medicare and Medicaid Services.

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By Paul Jenks Posted at 10:05 a.m.
Medicaid, Medicare

July 29, 2014

Medicare Trustees Report Extends Trust Fund Solvency

The trustees of the Social Security and Medicare trust funds on Monday released their annual report. The trustees projected that due to lower health care spending the Medicare hospital inpatient trust fund will be depleted in 2030, four years later than estimated last year.

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July 17, 2014

Final Medicare Payment Rules Loom

The Centers for Medicare and Medicaid Services has sent the White House the final payment rule proposals for fiscal 2015 Medicare provider payments for skilled nursing, psychiatric and inpatient rehabilitation facilities.

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July 11, 2014

Senate Highway Fund Fix Eyes Delinquent Medicare Providers

The long-reach of health care spending came into play Thursday as the Senate Finance Committee advanced a compromise bill to shore up the highway trust fund.

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July 10, 2014

Federal Auditors Question Lab Fees

The HHS inspector general has released a report on Medicare Part B spending for clinical laboratory services. HHS auditors examined lab payments from 2005-10, and despite a 10 percent increase in Medicare enrollment, lab payments increased by 29 percent.

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