CMS describes how sequester will be applied to Medicare payments   03/11/2013
Unless Congress acts to change the sequester, the Centers for Medicare & Medicaid Services will reduce Medicare fee-for-service payments by 2% for service/discharge dates and durable medical equipment/supply dates starting April 1, the agency announced Friday. CMS said it will apply the 2% reduction to all claims after determining coinsurance and any applicable deductible and Medicare secondary payment adjustments. Medicare payments to beneficiaries for unassigned claims also are subject to the 2% reduction, CMS said. The agency encouraged physicians, practitioners and suppliers who bill claims on an unassigned basis to inform beneficiaries of the impact of sequestration on Medicare’s reimbursement.
Medicare to begin enforcing program integrity requirement   03/11/2013
Effective May 1, the Centers for Medicare & Medicaid Services will implement claims edits to enforce a 2010 requirement that certain Medicare claims for home health, Part B laboratory and imaging services, and durable medical equipment identify the ordering or referring physician or eligible professional. In order for a claim to be paid, the listed ordering or referring physician must be currently enrolled in Medicare and eligible to order or refer the service or item being billed. Hospitals should confirm that physicians and non-physician practitioners from whom they accept orders and referrals are included in Medicare’s list of eligible practitioners, available at For more information, see the AHA’s June 2012 Regulatory Advisory and the CMS-issued MLN Matters article on this topic. CMS will host a March 20 conference call on the claims edits for affected health care providers. To register for the call, click here.
Columnist examines hospital billing   03/11/2013
In Forbes magazine, health policy contributor Chris Conover has taken a two-part look at claims made in the March 4 TIME magazine piece “Bitter Pill” about hospital billing and finances. The first article examines outcomes, overall spending and pharmaceutical prices, while the second piece looks at claims that high prices translate to high profits and that Medicare administration is more efficient than that of private health plans. Specifically, Conover examines several measures of profitability and determines that the hospital field’s profits are “very much in the middle of the pack (or lower) compared to other industries.”
AHA survey shows increase in RAC activity   03/11/2013
Hospitals continue to experience rapid growth in recovery audit contractor reviews, according to the latest results from the AHA's quarterly RACTrac survey. Medical necessity denials were the top reason Medicare RACs denied claims; however, nearly two-thirds of these denials were for care found to be provided in the wrong setting, not because the care provided was medically unnecessary. Survey respondents appealed 41% of denials with a success rate of 72%. Hospital representatives are invited to attend a free March 26 webinar to review recent RAC policy developments, the survey results and updates to questions in the free web-based survey, which helps hospitals monitor the impact of RACs and advocate for needed changes to the program. For more information, visit