Medical Billing Blog
The Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on all aspects of the Medicare program (cost, reimbursement, access, quality, etc.). MedPAC issues two annual reports to Congress, one in March and another in June. These reports contain the policy recommendations of the Commission.
Dr. Shantanu Agrawal, MD, the Director of CMS’ Center for Program Integrity (CPI) stated that CPI is going to shift its focus to preventing fraud rather than chasing overpayments down after they have already been paid. In a speech to the American Bar Association’s Health Law Summit, Agrawal said that “preventative actions have a greater return on investment than the pay and chase model, in which the government seeks the return of overpayments it has already made”.
A recent survey of more than 18,500 physicians finds that 22 percent of them are opting out of or disregarding altogether the meaningful use electronic health records program.
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.
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.
On April 30th, the House Committee on Ways and Means Subcommittee on Health held a hearing to solicit input from the HHS Inspector General’s office (OIG), CMS and the Government Accountability Office (GAO) on ways to improve Medicare oversight and reduce waste, fraud and abuse. Gloria Jarmon, Deputy Inspector General for Audit Services, Office of Inspector General, testified on behalf of HHS; Shantanu Agrawal, M.D., Deputy Administrator and Director, Center for Program Integrity, testified on behalf of CMS; and Kathy King, Director, Health Care testified on behalf of GAO.
Medicare providers who are unable to successfully demonstrate meaningful use for 2013 due to circumstances beyond their control can apply for a “hardship exemption.” CMS is accepting applications for hardship exceptions to avoid the upcoming Medicare payment reductions for the 2013 reporting year.
March 23rd 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 1st, 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.