Bill would improve Medicare audit programs   03/19/2013
Reps. Sam Graves (R-MO) and Adam Schiff (D-CA) today introduced the Medicare Audit Improvement Act (H.R. 1250), legislation strongly supported by the AHA to improve the Recovery Audit Contractor program and other Medicare audit programs. “America’s hospitals take seriously their obligation to properly bill for the services they provide to Medicare and Medicaid beneficiaries and recognize the need for auditors to identify billing errors,” said AHA Executive Vice President Rick Pollack. “However, a flood of auditing programs (Recovery Audit Contractors, Medicare Administrative Contractors and Comprehensive Error Rate Testing Contractors) is drowning hospitals with a deluge of duplicative audits, unmanageable medical record requests and inappropriate payment denials, diverting resources from care to redundant government audits. In fact, when hospitals decide to commit the time and resources necessary to fight RAC denials in the Medicare appeals process, they are successful at overturning the RAC denial 72% of the time. This legislation provides much needed guidance for auditors while keeping them out of making medical decisions that should be between patients and their physicians. It also will improve recovery auditor transparency and allow denied inpatient claims to be billed as outpatient claims when appropriate.”
AHA voices support for Fostering Independence Through Technology Act   03/19/2013
Sens. John Thune (R-SD) and Amy Klobuchar (D-MN) yesterday reintroduced the Fostering Independence Through Technology Act (S. 596). The AHA-supported legislation would create pilot projects aimed at increasing the use of remote monitoring technology for home health patients and reducing unnecessary hospital readmissions or patient transfers from home to higher acuity care settings. “The AHA has long advocated that patients receive the right care, in the right setting, at the right time,” AHA Executive Vice President Rick Pollack said in a letter of support for the bill. “Your legislation advances that objective by giving medical professionals the capability to monitor patients receiving care for specified conditions, including congestive heart failure, diabetes and other chronic diseases, through remote patient monitoring technology.”
AHA responds to AHIP report on hospital prices   03/19/2013
The AHA yesterday issued a statement in response to a report on hospital prices by America’s Health Insurance Plans, published in the March issue of the American Journal of Managed Care. “Today’s report is simply a rehash designed to divert attention from the harmful consumer impacts of health insurers' own rising premiums,” said AHA Executive Vice President Rick Pollack. “As a study by the American Medical Association found, anticompetitive market conditions are common across managed care plans. It’s important to note that growth in insurance costs from 2010 to 2011 was more than double that of the underlying health care costs, including hospitals. It is not hospital prices that are driving the rise in insurance premiums. The annual report of national health expenditures released in 2012 by [the Centers for Medicare & Medicaid Services’] office of the actuary found that premium rates for private insurers rose faster than underlying health care costs and that for the first time in seven years growth in total premiums exceeded growth in total benefits.” Pollack noted that the rate of growth in hospital cost per service is at a decade-low as hospitals pursue ways “to make care more affordable by better coordinating care, reducing red tape and providing the right care at the right time in the right setting.”
Study estimates coverage gap in ACA Medicaid expansion   03/19/2013
An estimated 17% of uninsured low-income adults will be ineligible for Medicaid coverage under the Patient Protection and Affordable Care Act due to their immigration status, according to a new report  from the Robert Wood Johnson Foundation. State-level estimates range from 3% in Mississippi to 34% in Nevada, the study found. “While all states will need to develop strategies for meeting the health care needs of these adults, the challenges will be particularly difficult for safety-net providers in states with large numbers of immigrants who will not be eligible for Medicaid,” the authors state. The ACA’s Medicaid expansion excludes unauthorized immigrants and immigrants with less than five years of legal residency.
CMS hosts webinars on e-health requirements for eligible professionals   03/19/2013
The Centers for Medicare & Medicaid Services is hosting a series of webinars to review the actions that eligible professionals must take in 2013 to earn incentives and avoid payment adjustments associated with the Physician Quality Reporting System, eRx Incentive Program, and Medicare and Medicaid Electronic Health Record Incentive Programs. To register to participate in the March 21, 22 and 27 webinars, click here. In addition, the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology has launched the first in a series of webpages that will offer health IT resources tailored to the needs of critical access hospitals and small, rural hospitals, to support ONC’s goal of having 1,000 CAHs and small, rural hospitals obtain meaningful use before 2015.