Medical Billing Blog

Health-insurance premiums for plans sold in the Affordable Care Act's exchanges will be lower than previously expected for the next few years, according to a report by the Congressional Budget Office released Monday. The Congressional Budget Office predicts that health insurance subsidies under the Affordable Care Act will total a little more than $1 trillion over the next 10 years, instead of almost $1.2 trillion initially estimated. CBO said the 8 percent cut results largely from tighter cost controls by insurance companies offering plans on health care exchanges. Generally speaking, the plans offered on the exchanges pay health care providers less and have tighter management of patients’ treatment options, and that means lower premiums and taxpayer subsidies.

Under the Medicare Recovery Audit Contractor (RAC) program, the Contractors get paid a percentage of the” inappropriate” payments they identify and recover.  Some have compared this to a Medicare “bounty hunter” program.

Kathleen Sebelius, the health and human services secretary, is resigning, ending a stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act. Sebelius was not pressured to resign, according to major news outlets. She informed Mr. Obama in early March of her decision to resign, a White House official said. "At that time, Secretary Sebelius told the president that she felt confident in the trajectory for enrollment and implementation of the Affordable Care Act, and that she believed that once open enrollment ended it would be the right time to transition the department to new leadership," the official said.

This week the Centers for Medicare and Medicaid Services (CMS) released raw data on how individual medical providers treat America’s seniors. This is a historical publication into how Medicare expenditures are distributed because access has been denied since 1979, when a Florida court issued a permanent injunction barring the government form releasing information about Medicare Part B payments to individual physicians in any manner that would allow the doctor to be identified. However, in 2011, the parent company of The Wall Street Journal successfully sued to overturn the injunction.  

On Tuesday, March 4, the Office of Management and Budget (OMB) released the President’s budget for Fiscal Year (FY) 2015. This budget is not a binding document and will likely result in no real action. The President’s budget is considered an indication of the President’s priorities for the upcoming fiscal year. It is important to understand the budget because certain provisions of it may be included in future proposals and legislation.

March 23^rd marked the four-year anniversary of enactment of the Affordable Care Act (ACA). Most of the past four years have been spent developing the infrastructure and refining the policies to implement the law. Implementation began on October 1^st, 2013, when the first open enrollment period went live. Now, as the first open enrollment period comes to an end, it seems like an appropriate opportunity to examine the state of the ACA as “phase one” comes to an end.

The Medicare Payment Advisory Commission (MedPAC) is required by law to annually review Medicare payment policies and make recommendations to Congress. Consistent with previous Reports, MedPAC’s recommendations address long term concerns with increasing healthcare spending and short term concerns with various Fee-For-Service (FFS) policies.

The state of Michigan has officially rolled out its Medicaid expansion program. Governor Rick Snyder, a Republican, fought his GOP-controlled legislature last summer to push through the expansion. But lawmakers refused to let it take effect earlier than April 1. Eligibility for this year is expected to be around 320,000 people.  Further expansion is expected to cover about 470,000 residents through increasing the income limit for eligibility. Some elements of Michigan's Medicaid expansion program will require CMS approval. Currently, in order to qualify, adults must between the ages of 19 and 64 who are not currently eligible for Medicaid or Medicare, and are making less than 133 percent of the federal poverty line. The current FPL is about $16,000 for a single person and $33,000 for a family of four. The state plan notably includes a provision requiring enrollees after four years to seek exchange coverage or share some of the costs to remain in the Medicaid program. Interest in the Michigan program looks strong early on. By 4 p.m. Tuesday, the state reportedly received almost 12,000 applications for coverage.

President Barack Obama celebrated the end of the Affordable Care Act’s first open enrollment period by announcing that at least 7.1 million Americans have signed up for insurance through exchanges. "No, the Affordable Care Act hasn’t fixed our long broken health care system, but this law has made our broken system a lot better," Obama said before a large and happy crowd Tuesday afternoon in the Rose Garden. The tally is based on the number of people who enrolled for coverage by Monday’s deadline through the new federal insurance marketplace operating in three dozen states. It also includes people who enrolled in 14 state-run marketplaces as of the deadline or, in the case of a few states, by last weekend. The Census Bureau estimates that 47 million Americans went without health insurance last year, more than 15 percent of the population. White House press secretary Jay Carney said Tuesday that the administration expects that the final numbers will also show sharply higher enrollment by young adults, though demographic breakdowns by race or age will not be available for days or weeks, and he was unable to say how many of the enrollees were previously uninsured. The law’s impact on the uninsured, he said, was intended to be measured over three years.

The United States Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring today as previously scheduled.  Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months.   Although the legislation must be signed by the President in order to become effective, the President has indicated that he will sign this legislation once it reaches his desk.