HHS issues PCIP, MLR rules   05/17/2013
The Department of Health and Human Services today released an interim final rule setting payment rates for covered services furnished to individuals enrolled in the Pre-Existing Condition Insurance Plan program administered by the department beginning with covered services furnished on or after June 15. The rule will require providers to accept Medicare rates for services provided to PCIP participants in those states where the federal government operates the program. The rule also will prohibit balance billing. AHA staff are analyzing the rule, which will be published in the May 22 Federal Register, and members will receive a Special Bulletin with further detail on Monday. The Centers for Medicare & Medicaid Services today also released a final rule implementing the medical loss ratio requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program established under the Patient Protection and Affordable Care Act.
AHA urges changes to CMS proposed rule on rebilling   05/17/2013
While the Centers for Medicare & Medicaid Services’ proposed rule on Medicare Part B rebilling recognizes that the agency’s prior policy of denying full payment for Part B claims is unlawful, the rule contains a number of restrictions that would compromise hospitals’ ability to rebill for medically necessary patient services, the AHA told the agency today. “The proposed rebilling rule will require significant modifications in order to provide hospitals with a fair and equitable process for securing payment for the reasonable and necessary services provided to patients when there is a dispute about the setting in which care should have been delivered,” AHA Executive Vice President Rick Pollack wrote in response to CMS’ March 13 proposed rule. The AHA said the final rule should permit rebilling of any denied claim that originally was timely filed, rather than restrict rebilling to services provided in the prior 12 months; ensure full reimbursement of all reasonable and necessary services provided  rather than arbitrarily exclude services that require “outpatient status”; and restore full and fair appeal rights for hospitals that choose to exercise their right to appeal denied claims rather than arbitrarily narrow the scope of that review.
AHA submits health IT feedback to senators   05/17/2013
The AHA today submitted comments to six Republican senators in response to their white paper and request for stakeholder feedback on federal progress to promote health information technology adoption and standards. AHA Executive Vice President Rick Pollack said hospitals are making progress in adopting electronic health records, but expressed concern that small and rural hospitals are lagging behind their large urban counterparts. He also expressed concern that meaningful use rules under the Medicare and Medicaid EHR incentive programs continue to be too complex and burdensome, but said it would be unfair to those who have made significant investments if Congress were to stop the incentive payments. He also shared AHA’s suggestions for removing barriers to health information exchange; recommended improvements to meaningful use audits; and said hospitals and physicians “need to know that the EHRs and other tools they purchase are transparent and support compliance with current coding conventions.”
CMS updates EHR program guidance for CAH physicians   05/17/2013
The Centers for Medicare & Medicaid Services has issued updated guidance that explains how certain physicians who provide services in the outpatient departments of critical access hospitals can participate in the Medicare Electronic Health Record Incentive Program beginning this year. The affected physicians are those for whom a CAH bills Medicare for their outpatient department services using optional Method II. Under this method, the CAH bills Medicare on behalf of the physician for services covered under the Medicare Physician Fee Schedule. Due to system constraints, CMS did not include these Method II claims when it identified which physicians were eligible for its incentive programs. As a result, Method II physicians were inappropriately excluded from the EHR incentive program because they were designated as "hospital-based" when they are not. In response to concerns raised by the AHA and others, CMS is implementing system changes to allow these physicians to participate.
House holds hearing on FHA mortgage insurance programs   05/17/2013
The House Financial Services Subcommittee on Housing and Insurance yesterday held a hearing on the government’s role in providing mortgage insurance for health care and multifamily facilities. Roger Miller, deputy assistant secretary for Federal Housing Administration health care programs, said the Section 242 hospital mortgage insurance program supports underserved hospitals that have sound track records but are unable to secure capital to operate a financially stable facility at reasonable interest rates. “By insuring mortgages for these hospitals, FHA enables the financing of projects…at rates that ultimately reduce health care costs,” he said. The Housing and Urban Development appropriations bill includes language that would make critical access hospitals eligible for the program. “Before their eligibility expired in 2011, 29 critical access hospitals received FHA-insured loans, with results that were positive, both in terms of loan performance and the jobs created by hospital construction projects,” Miller noted. In his opening statement, Subcommittee Chairman Randy Neugebauer (R-TX) questioned whether the FHA has extended into areas beyond its historical mission.
Members-only Town Hall webcast Wednesday on disparities initiative   05/17/2013
Tune in for the next AHA members-only Town Hall Interactive webcast Wednesday at 4 p.m. Eastern Time. AHA President and CEO Rich Umbdenstock will be joined by guests representing partners in the National Call to Action to Eliminate Health Care Disparities. Together they will announce goals and milestones in the initiative, and discuss progress the hospital field has made to decrease disparities and promote diversity in health care. Hosted by AHA leaders, members-only Town Hall Interactive webcasts focus on advocacy and other important developments in the hospital and health care field. To participate in the 2013 webcasts, register here. For more information, call (800) 424-4301.