OMHA hosts forum on audit appeals backlog   02/13/2014
The Department of Health and Human Services’ Office of Medicare Hearings & Appeals yesterday held a forum on the growing backlog of appealed claims awaiting a hearing by an administrative law judge. OMHA staff discussed initiatives to streamline the process of filing an appeal, including a future electronic appeals system, and offered suggestions on how providers can format their appeals to make the process more efficient. At the forum, AHA Senior Associate Director of Policy Melissa Jackson agreed that reform is needed in the appeals system, but that the Centers for Medicare & Medicaid Services must also address the high level of inaccurate denials faced by hospitals. “Given that the Office of Inspector General has documented that hospitals are successful at winning overturn of Medicare Part A denials 72% of the time, it is clear that CMS needs to examine the most common denials that are overturned by an ALJ and provide additional education to its Recovery Audit Contractors to avoid inappropriate denials in the first place,” she said. Last month, AHA urged CMS to work with OMHA to develop a lasting solution to a two-year backlog on ALJ hearings.
AHA urges CMS to align quality program goals, then measures   02/13/2014
The Centers for Medicare & Medicaid Services could “foster quality improvement most effectively by establishing clear and meaningful national goals with specific and measureable objectives that could be used throughout the department,” AHA said in comments submitted yesterday on the agency’s proposed Quality Strategy. “CMS then could use these goals and objectives to align and streamline its quality measurement and reporting efforts, measures embedded in payment programs and other regulatory activities, such as conditions of participation and conditions of coverage, to stimulate the accomplishment of the objectives,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development. AHA urged the agency to work with the National Priority Partnership to identify a small number of national priority areas, and with the Measure Applications Partnership to identify the measures that best address those priorities within each payment or public reporting program.
HHS: Marketplace enrollments up 53% in January   02/13/2014
More than 1.1 million people selected a private health plan through state or federally-facilitated health insurance marketplaces in January, bringing the total since October to nearly 3.3 million, the Department of Health and Human Services reported yesterday. The January numbers show a 53% increase in total enrollees and a 65% increase in young adult enrollees since December. The figures include people who have not yet paid their first month’s premium. About 27% of January enrollees were adults under age 35, up from 24% previously. About six in 10 people selected a silver plan and two in 10 a bronze plan. About eight in 10 people who selected a plan qualified for federal financial assistance in paying their premiums. In addition to private plan enrollments by state, metal level, age and gender, the report shows 3.2 million people submitting applications through the new marketplaces since October have been deemed eligible for Medicaid or the Children’s Health Insurance Program. The first open enrollment period for the marketplaces closes March 31.
Rhode Island hospitals boost economy by $6.7 billion   02/13/2014
Rhode Island hospitals contributed $6.7 billion to the state's economy in 2012, according to a new report by the Hospital Association of Rhode Island. In addition to employing 20,800 health care professionals, the hospitals spend more than $1.4 billion a year on goods and services to deliver quality care, creating additional jobs and spending throughout the local economy. "The financial health of hospitals is directly tied to the strength of our state overall,” said HARI President Edward Quinlan. “Hospitals must be financially strong to continue investing in our state’s economy.”
Reminder: Complete IFD/HRET diversity survey by Feb. 28   02/13/2014
The Institute for Diversity in Health Management and Health Research & Educational Trust encourage all hospitals to complete a survey about their efforts to address health care disparities and improve diversity management practices. The survey was mailed to hospital CEOs, and all hospitals are encouraged to complete it by Feb. 28. Aggregate results will be shared at the Institute’s 2014 National Leadership and Education Conference June 12-13 in Chicago. In addition, all responding hospitals will be eligible to receive a custom benchmarking report relating their performance to that of other responding organizations. For more information, contact Kevin Kenward at The Institute and HRET are AHA affiliates.