CMS announces RAC program changes, 'pause' in audits   02/19/2014
The Centers for Medicare & Medicaid Services will soon “pause” additional documentation requests by Recovery Audit Contractors until new RAC contracts are in place, the agency announced yesterday. The pause in requests will begin Feb. 21 for post-payment reviews and Feb. 28 for pre-payment reviews. CMS also announced five changes to the RAC program that will be included in the next round of RAC contracts. The changes are small steps toward addressing significant hospital concerns with the administrative burden caused by the RAC program, but do not address lengthy delays in the RAC appeals process or discourage RACs from making inappropriate denials in the first place. AHA will continue to urge CMS to address those concerns, and Congress to enact reforms contained in the Medicare Audit Improvement Act (H.R. 1250/S. 1012). AHA members today were sent a Special Bulletin on the planned contract changes, and will receive updates as additional information is available.
CMS must expedite ICD-10 testing, AHA tells national panel   02/19/2014
Hospitals remain concerned that the Centers for Medicare & Medicaid Services has not begun the end-to-ending testing of ICD-10 electronic transactions and claims adjudications that will be essential to meeting the Oct. 1 implementation date, the AHA today told a National Committee on Vital and Health Statistics ICD-10 panel. “We urge CMS to expedite the testing process to begin as soon as possible and ensure all testing is complete by the end of June so that providers, payers and clearinghouses can resolve any issues discovered during testing and complete training well in advance of the Oct. 1 transition date,” said George Arges, senior director of AHA’s health data management group. Arges also discussed two key components – testing for connectivity and testing for content – that should be involved in the ICD-10 testing process and shared an AHA chart detailing how testing should flow. At today’s NCVHS meeting, CMS announced that it would begin limited end-to-end testing for ICD-10 this summer, and agency representatives said that no further delays in implementation of ICD-10 would be granted.
Federal judge dismisses second challenge to premium tax credits   02/19/2014
A federal district court in Virginia yesterday dismissed a case challenging premium tax credits for lower income Americans in states with federally-facilitated health insurance exchanges. The court sided with the government in upholding an Internal Revenue Service rule providing premium tax credits to help low- and middle-income individuals afford insurance purchased through exchanges, whether state-run or federally-facilitated. Among other reasons, U.S. District Judge James Spencer wrote, “What is clear is that there is no direct support in the legislative history of the [Affordable Care Act] for Plaintiffs' theory that Congress intended to condition federal funds on state participation.” The U.S. District Court for the District of Columbia rejected a similar challenge to the premium subsidies in January, which the U.S. Court of Appeals for the D.C. Circuit yesterday affirmed. AHA submitted friend-of-the-court briefs supporting the government in both cases.
Hospitals back PA proposal to expand Medicaid coverage   02/19/2014
The Hospital & Healthsystem Association of Pennsylvania will ask the Centers for Medicare & Medicaid Services to quickly approve the state’s application for a Medicaid demonstration waiver to increase coverage for more than 500,000 residents, HAP President and CEO Andy Carter said today. “Since the introduction of the Healthy Pennsylvania initiative, HAP has been engaged in productive conversations with the Corbett administration to refine the details of the state’s proposed Healthy Pennsylvania 1115 Demonstration Application,” Carter said. “As a result of these discussions, we fully support the final document, as it offers an effective and workable program to address the health care and wellness needs of low-income Pennsylvanians.”
Health system leader named next IOM president   02/19/2014
Duke University Health System President and CEO Victor Dzau, M.D., will become the next president of the Institute of Medicine, the National Academy of Sciences announced today. Dzau also serves as chancellor for health affairs at Duke University and James B. Duke Professor of Medicine, and is a past chair of the Association of Academic Health Centers. He will begin a six-year term as IOM president effective July 1, succeeding Harvey Fineberg, who has served for 12 years. “Victor Dzau is an internationally acclaimed leader and scientist whose work has improved health care in the United States and globally,” said NAS President Ralph Cicerone. Established in 1970, the IOM is the health arm of the National Academy of Sciences, a private nonprofit institution that provides science, technology and health policy advice to the federal government and other organizations.