Medical Billing Blog

CBO Losing Track of ACA Fiscal Impact

Posted by Scott Shatzman on Wed, Jul, 09, 2014 @ 07:07 AM

In its latest April 2014 report on the Affordable Care Act (ACA), the Congressional Budget Office (CBO) announced that it is no longer possible to project the overall fiscal impact of the health care law.

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ONC and CMS Delay Meaningful Use

Posted by Scott Shatzman on Fri, May, 23, 2014 @ 08:05 AM
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SGR Update: SGR Patch/ICD-10 Delay Passed

Posted by Scott Shatzman on Tue, Apr, 01, 2014 @ 07:04 AM

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. 

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SGR Update: March 28th House Edition

Posted by Scott Shatzman on Fri, Mar, 28, 2014 @ 10:03 AM

Yesterday, by a voice vote, the House of Representatives passed legislation postponing the 24% physician fee schedule cut slated to take effect on April 1, 2014.  However, the legislation went well beyond just temporarily fixing the SGR problem, it also made a number of other changes that will have long-lasting implications.  A listing of those changes is at the end of this message.

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Sebelius: No More Health Law Delays

Posted by Scott Shatzman on Fri, Mar, 14, 2014 @ 08:03 AM

Kathleen Sebelius, the secretary of health and human services, said Wednesday that the Obama administration would not extend the deadline for people to sign up for health insurance or delay the requirement for most Americans to have coverage. There will also be no delay in the penalty most Americans face under President Barack Obama's healthcare reform law if they fail to obtain health coverage this year. Last year, embracing nonpartisan estimates for the Affordable Care Act, Health and Human Services Secretary Kathleen Sebelius set a benchmark for the new insurance marketplaces: "Success looks like at least 7 million people having signed up by the end of March 2014," she said to NBC. Enrollment, however, began at a terribly slow pace in October because of all the technical problems with, the federal health exchange website serving 36 states. Some state-run health exchange websites have had their own problems as well. Within that context, Sebelius on Wednesday redefined what success looks like: "Success looks like millions of people with affordable health coverage, which we will have by the end of March," she told the House Ways and Means Committee. The administration released the latest enrollment figures on Tuesday—revealing that some 4.2 million Americans have signed up for coverage on the new exchanges. However, that figure does not include how many people have actually paid for their plans—a metric that could make the actual number of enrollees significantly lower.

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Proposed Medicare Part D Changes Are Postponed

Posted by Scott Shatzman on Tue, Mar, 11, 2014 @ 09:03 AM

The Obama administration has dropped plans to change the Medicare prescription drug program amid criticism from industry, patient advocacy groups and lawmakers that the changes would limit seniors’ access to certain medications and choice of plans. CMS Administrator Marilyn Tavenner wrote in a letter to Congress Monday that she was shelving changes proposed in January that could have loosened the requirements that Medicare Part D insurance plans cover a broad range of drugs in six “protected classes” of medications. Since the start of Medicare’s prescription drug benefit in 2006, the government has required insurers to cover “all or substantially all” drugs in six treatment areas. The administration proposed in January to lift the requirement for three types of medications: immunosuppressant drugs used in transplant patients; antidepressants; and antipsychotic medicines, used to treat schizophrenia and certain related disorders. Medicare officials had said the proposal would have saved money and reduced the overuse of drugs.

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Obama Administration Unveils New Affordable Care Act Changes… again.

Posted by Scott Shatzman on Fri, Mar, 07, 2014 @ 07:03 AM

The Obama administration announced Wednesday that it has rewritten an array of far-reaching rules under the Affordable Care Act, the most significant of which will let people keep bare-bones health insurance policies for three more years. Americans with health insurance policies that don't meet consumer standards set by the president's healthcare law would be allowed to keep their plans into 2017, three years later than originally envisioned, so that people can buy these noncompliant plans through October 2016 and be covered by them until the following September, when Obama’s tenure in the White House will have ended. The healthcare law was designed to phase out health insurance plans in 2014 if they did not include a basic set of benefits and limits on how much consumers can be required to pay out of pocket for their medical care. After the controversy broke, the administration announced in November that state regulators could allow insurers to renew old policies in 2014. Only about half the states have agreed to the extensions. Some, particularly those with liberal, Democratic insurance regulators, have balked at allowing what they consider substandard plans to remain on the market.

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Obama Administration Delays Part Of Employer Mandate Again

Posted by Scott Shatzman on Tue, Feb, 11, 2014 @ 07:02 AM

The Obama administration announced Monday it would give medium-sized employers an extra year, until 2016, before they must offer health insurance to their full-time workers. Firms with at least 100 employees will have to start offering this coverage in 2015. Small businesses with fewer than 50 workers have always been exempt from the new coverage requirements but the law originally required all other businesses to start covering their workers for face penalties beginning Jan. 1, 2014. Under the Affordable Care Act, larger employers are generally subject to tax penalties if they fail to offer "minimum essential coverage" to full-time employees and their dependents. The administration laid out a three-tier approach. For larger employers with 100 or more employees (about 2 percent of employers): Seventy percent of employees must be offered coverage in 2015, and in later years at least 95 percent of employees must be offer coverage. Employers that do not meet these standards will be subject to tax penalties. For employers with 50 to 99 employees (about 2 percent of employers): Companies with 50 to 99 employees will have an extra year, until 2016, to provide coverage or pay tax penalties. For small businesses with fewer than 50 employees (about 96 percent of all employers): These companies will not be required to provide coverage or fill out any forms in any year. Officials Monday said that the delay in the Affordable Care Act mandate will affect 50 percent of the businesses that were supposed to be complying by 2015. About 7.8 million workers are employed by the affected businesses. However, those officials also took pains to note that the so-called employer mandate to offer affordable health insurance to workers does not affect 96 percent of the employers in the U.S., because they have fewer than 50 full-time employees.

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