Medical Billing Blog

Federal officials on Wednesday released new data about who enrolled in the federal health marketplace plans for 2014, how much the law’s subsidies helped offset the cost and how many plans people from could choose from, among other details.

 The latest look at the U.S. health care system compared to other rich countries shows — yet again — that the United States comes in dead last.

Eligible professionals participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. Payment adjustments will depend on program participation and start year.

Shortly before appearing before the House Oversight and Government Reform Committee, the Government Accountability Office (GAO) issued a report on Medicare mismanagement. The report summarizes existing program integrity procedures in the Medicare program and describes additional GAO program integrity recommendations that have yet to be implemented by CMS.

This month the Centers for Medicare and Medicaid Services (CMS) issued final regulations for the Medicare Advantage and prescription drug benefit (Part D) programs. The proposed new requirements largely aim to improve the integrity and efficiency of Medicare Part C and Part D, the prescription drug program. CMS projects that the rule will save an estimated $1.615 billion over the next ten years 2015-2024.  

Individual eligible professionals (EPs) or those that are part of a group practice participating in PQRS must satisfactorily report data on quality measures during 2014 to avoid the 2016 payment adjustment. CMS has produced a document entitled 2016 PQRS Payment Adjustment that explains how to avoid the payment adjustment.

As has been previously reported, on April 1, 2014, the Protecting Access to Medicare Act of 2014 was signed into law by President Obama after swift passage by the House and Senate.  Language was included in this legislation that prohibited the Secretary of Health and Human Services from mandating use of ICD-10 PRIOR to October 1, 2015.

Department of Health and Human Services announced to a Washington, D.C. forum this month that they are committed to more public releases of Medicare claims data and that they recognize that data transparency is a key aspect of transformation of the health care delivery system.

On Tuesday, May 20, 2014, CMS released a proposed rule that would make changes to the current Certified EHR Technologies (CEHRT) requirements and formally extend Stage II of Meaningful Use through 2016.

Earlier this month, CMS released the final version of the Exchange and Insurance Market Standards for 2015. This final rule outlines how the healthcare market places will function in 2015. The rule finalizes policies regarding consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for Navigators and other consumer assisters, and policies regarding the premium stabilization programs, among other standards.