AHA urges CMS, Congress to address delay in RAC-related appeals   01/14/2014
AHA today urged the Centers for Medicare & Medicaid Services to work with the Office of Medicare Hearings and Appeals to develop a lasting solution to a two-year backlog on Administrative Law Judge hearings being driven by inappropriate denials by Medicare Recovery Audit Contractors. “It is clear that the RAC program and the resulting volume of inappropriate claim denials are putting significant strain on the appeals process,” wrote AHA Executive Vice President Rick Pollack. “And hospitals are bearing the financial burden with over a billion dollars caught in a broken appeals process that takes several years to issue a final determination….Suspension of RAC audits until all levels of the determination and appeals process catch up with their current workloads would be the most straightforward solution, particularly since the next round of RAC contracts has not yet been finalized.” In a separate letter, AHA urged the 177 congressional co-sponsors of the Medicare Audit Improvement Act (H.R. 1250/S. 1012) to encourage CMS to adopt the RAC reforms contained in the legislation and to stop recouping disputed funds until after the hospital has received an ALJ determination.
AHA: Medicare, Medicaid underpaid hospitals by $56 billion in 2012   01/14/2014
Underpayment by Medicare and Medicaid to U.S. hospitals reached $56 billion in 2012, according to a factsheet released today by the AHA. Based on data from the AHA’s Annual Survey of Hospitals, Medicare reimbursed just 86 cents and Medicaid 89 cents for every dollar hospitals spent caring for these patients in 2012. As reported earlier this month, U.S. hospitals also provided $45.9 billion in uncompensated care (charity care and bad debt) in 2012, $4.8 billion more than in 2011.
AHA chart details repeated cuts to payment for hospital services   01/14/2014
Medicare and Medicaid payments to hospitals have been cut by an estimated $113 billion since 2010, according to a chart released today by the AHA. The figures represent the 10-year impact of legislative and regulatory actions on hospital payment since 2010, excluding cuts included in the Patient Protection and Affordable Care Act.
CMS to host Jan. 16 call on marketplaces, QHPs   01/14/2014
The Centers for Medicare & Medicaid Services will host a national call to update providers on the health insurance marketplace and qualified health plans on Jan. 16 at 1 p.m. Eastern Time. Hospital and health system staff should call (855) 258-3677 and use the conference ID 34470517 to participate. Questions should be submitted in advance to Partnership@cms.hhs.gov, and additional CMS resources for providers and consumers are available at http://marketplace.cms.gov.
HHS updates Marketplace enrollment data   01/14/2014
Nearly 2.2 million people selected a health plan through the new Health Insurance Marketplaces between Oct. 1 and Dec. 28, according to a report released yesterday by the Department of Health and Human Services. An increase from roughly 364,000 before December, the count includes people who have not yet paid their first month’s premium. About 56% of enrollees selected a plan through a federally-facilitated marketplace and the rest through a state-based marketplace. About six in 10 enrollees selected a silver plan, and three in 10 were under age 35. More than three-quarters of people who selected a plan will receive federal financial assistance in paying their premiums, HHS said. In addition, nearly 1.6 million people submitting applications through a marketplace were deemed eligible for Medicaid or the Children’s Health Insurance Program, according to the report.
Reminder: Webinar Thursday to discuss new RAC Analyzer tool   01/14/2014
Hospital staff are invited to attend a free Jan. 16 webinar on a new AHA online tool that allows hospitals to compare the impact of Medicare’s Recovery Audit Contractor program based on RAC region, bed size, ownership status and other variables. Participants will learn how to use the free RACTrac Analyzer with AHA’s existing RACTrac survey to create reports that compare their hospital’s RAC activity with those of similar hospitals. To register for the webinar, at 2 p.m. Eastern Time, click here. For more on the AHA’s free RACTrac survey, including the latest results and how to register, visit www.aharactrac.com.