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MedPAC Calls for End of “Two-Midnight Rule”

The independent agency that advises Congress on Medicare payment issues has recommended that Medicare eliminate its controversial two-midnight rule.
At its recent meeting in Washington, D.C., the Medicare Payment Advisory Commission (MedPAC) also recommended that Medicare focus RAC (Recovery Audit Contractor) audits on hospitals with the highest numbers of short inpatient stays, shorten the look-back period for audits, modify the three-day rule for skilled nursing facility coverage, and require hospitals to inform patients when their stay has been classified as observation status rather than inpatient status.
Learn more about MedPAC’s recommendation in this Fierce Healthcare news report and go here to see the MedPAC presentation of the recommendations the agency’s board approved.

2015-04-16T06:00:40+00:00April 16th, 2015|Medicare|Comments Off on MedPAC Calls for End of “Two-Midnight Rule”

OIG Reiterates Medicare, Medicaid Recommendations

Every year the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) examines the operations of various department offices, programs, and policies and offers recommendations for changes and improvements.  Some of those recommendations are adopted and others are not.
The OIG annually publishes a document reiterating what it believes to be its most important and potentially useful recommendations that were not adopted, and that publication was just released.
Among the Medicare and Medicaid recommendations it has presented again are:

  • Establish accurate and reasonable Medicare payment rates for hospital inpatient services.
  • Establish accurate and reasonable Medicare payment rates for hospital transfers.
  • Reduce hospital outpatient department payment rates for ambulatory surgical center-approved procedures.
  • Prevent inappropriate payments to Medicare home health agencies.
  • Reduce inappropriate payments to skilled nursing facilities.
  • Prevent payments for ineligible Medicare beneficiaries.
  • Reconcile Medicare outlier payments in accordance with federal guidance and regulations.
  • Ensure that states calculate accurate costs for Medicaid services provided by local providers.
  • Ensure the collection of identified Medicare overpayments.
  • Improve oversight of management of Medicaid personal services.
  • Improve the Medicare appeals process at the administrative law judge level.
  • Enhance efforts to identify adverse events to ensure quality of care and safety.
  • Ensure that Medicare children receive all required preventive screening services.
  • Strengthen oversight of state access standards for Medicaid managed care.

In its Compendium of Unimplemented Recommendations/March 2015, the OIG presents the issues and its rationale for its recommendation and describes the status of implementation, including, in some cases, why CMS has chosen not to implement its recommendations.
Find the report here.

2015-03-25T06:00:00+00:00March 25th, 2015|Medicare|Comments Off on OIG Reiterates Medicare, Medicaid Recommendations

House May Address Doc Fix Bill This Week

Means-testing for Medicare beneficiaries.
Modest raises for doctors now and the promise of no cuts for a decade.
An extension of the Children’s Health Insurance Program (CHIP) for ten years.
These and other provisions are part of a new bill expected to move to the House this week that would eliminated the use of the Medicare sustainable growth rate formula (SGR) that threatens to cut Medicare payments to doctors 21 percent beginning on April 1.
Doctor listening to patientFor years Congress has implemented temporary measures to prevent similar cuts but now, it appears to be serious about addressing the problem permanently by eliminating the SGR formula and introducing in its place a new payment system for doctors that pays them based on the quality rather than the quantity of care they deliver.
What’s in this latest proposal?  Kaiser Health News has published an FAQ that describes the issue, the proposed solutions, and the challenges those solutions face in the coming days.  See that FAQ here.
 

2015-03-24T06:00:58+00:00March 24th, 2015|Medicare|Comments Off on House May Address Doc Fix Bill This Week
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