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Showing 57 posts in Centers for Medicare & Medicaid Services (“CMS”).

The Wrap-Around Slap-Around for Primary Care Centers

January 17, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), Federally Qualified Health Centers (“FQHCs”), Health Care Law, Kentucky Primary Care Centers (“PCCs”), Managed Care Organizations (“MCOs”), Medicaid, Rural Health Centers (“RHCs”)

For Kentucky Primary Care Centers (“PCCs”), Rural Health Centers (“RHCs”), and Federally Qualified Health Centers (“FQHCs”), getting the run-around from Medicaid on wrap-around payments is not so unusual.  Frequently, these providers complain that supplemental payments distributed by the Kentucky Department for Medicaid Services’ (“Medicaid”) are too low, too late or both. More >

Tags: Health Care Law

Accountable Care Organizations Program Models

August 13, 2012
Posted In Accountable Care Organizations (“ACO”), Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare

The Supreme Court’s decision upholding the Affordable Care Act supports The Centers for Medicare and Medicaid Services (CMS) different programs for the development of Accountable Care Organizations (ACOs).  In Kentucky, we are beginning to see these organizations emerge in different models. More >

Tags: Health Care Law

Federal Medicaid Opt-Out Effect on Hospitals

August 2, 2012
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

The mandatory expansion of Medicaid was an important element of the Affordable Care Act as providing health care benefits to uninsured was intended to achieve equity.  The expansion of Medicaid rolls was also intended to reduce the cost of providing care for the uninsured and the need for disproportionate share hospital funding, which is an adjustment to account for the needs of hospitals serving a large number of low-income patients.  With the ability to opt out of the Affordable Care Act’s expansion of Medicaid eligibility (read more: The Federal Medicaid Apple:  Poison or the Cure?), the opt-out states may create financial problems for hospitals that depend on disproportionate share payments to cover part of their costs for providing non-reimbursed services to the indigent and uninsured.  The Affordable Care Act’s decrease in disproportionate share payments to hospitals is not changed by the Supreme Court’s ruling. More >

Tags: Health Care Law

The Federal Medicaid Apple: Poison or the Cure?

July 30, 2012
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

As the uncertainty about healthcare reform was extinguished by the Supreme Court in its 5-4 decision upholding the Affordable Care Act, with the provision that the Department of Health and Human Services may not withhold Medicaid funding from states that refuse to adopt the Medicaid expansion, all states, including Kentucky, now have important decisions to make about expansion of Medicaid to a projected 22.3 million uninsured eligible individuals.  Under the Affordable Care Act, the federal government will pay the full cost of covering the newly eligible Medicaid participants for three years from 2014 to 2016.  Thereafter the federal share will gradually decline until it reaches 90% in 2020.  For traditional Medicaid, the federal government now pays, on average, about 57% of a state’s total Medicaid costs.  With 826,941 Kentucky Medicaid beneficiaries in January 2012, and an additional 290,000 individuals that would be covered under the expansion, Governor Steve Beshear has announced that he is studying the issues and the costs. More >

Tags: Health Care Law

HOSPITAL PAYMENT FOR PERFORMANCE: DRIVEN BY PHYSICIAN’S QUALITY

April 17, 2012
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Department of Health and Human Services (HHS), Health Care Law, Medicaid, Medicare

As the fate of the Affordable Care Act is being determined by a divisive Supreme Court, the health care industry is being led or possibly dragged by the Department of Health and Human Services (“HHS”) and the Center for Medicare and Medicaid Services (“CMS”) into new payment systems that focus on quality of care, outcomes and individual provider performance rather than the traditional fee for service payment model.  Even if the Supreme Court finds the Affordable Care Act to be unconstitutional, the change from a payment system focused upon individual services to payment focused upon the quality of the care and patient outcomes are being woven into the fabric of the Medicare reimbursement system.  While change in the system is assured, whether the new models will actually bring about better and more efficient care or just reduce available reimbursement is unknown.  Despite the unknown effect of paying for performance based upon quality, CMS is marching on with new programs and payment penalties.  Physicians, whether employed by a hospital or in a private practice, should be aware of how quality is beginning to drive hospital reimbursement as well as the importance of the physician’s role in determining the quality of care provided by hospitals.  By 2017, 6% of all DRG payments will be subject to quality measures through new CMS payment programs for hospital readmissions, value based purchasing and hospital acquired conditions.  With these new programs determining a significant amount of payment, physicians must understand the programs and direct their services accordingly.  Likewise, hospitals must develop ways to compensate physicians for providing high quality care in a manner that allows hospitals to earn performance payments. More >

Tags: Health Care Law

CMS Has Issued Proposed Rule Which Would Force Providers to Report Overpayments in 60 Days

March 7, 2012
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

The Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations on Tuesday, February 14, 2012 proposing that providers and suppliers must report any self-identified overpayments within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is the latter. More >

Tags: False Claims Act, Health Care Law
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