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Showing 55 posts in Medicaid.

Reforming Medicare Audits

November 8, 2012
Posted In Health Care Law, Medicaid, Medicare, Medicare Audit Improvement Act of 2012, Recovery Audit Contractors (“RAC”)

On October 16, 2012, the Medicare Audit Improvement Act of 2012[1] was introduced in the U.S. House of Representatives by Representative Sam Graves. The purpose of this legislation is to reform the Medicare auditing program. This legislation aims to improve the accuracy and transparency of Medicare audits of hospitals as well as increase the accountability of Recovery Audit Contractors (“RAC”).[2] More >

Tags: Health Care Law

Changes to Deadlines for Stage Two – Meaningful Use in the Medicare and Medicaid EHR Incentive Programs

October 25, 2012
Posted In Critical Access Hospitals (“CAHs”), Electronic Health Records (“EHR"), Health Care Law, Health Information Technology for Economic and Clinical Health Act (HITECH Act), Medicaid, Medicare

Under the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, health care professionals and hospitals may qualify for incentive payments when they adopt and meaningfully use certified electronic health records (“EHR") under a three stage process. More >

Tags: Health Care Law

Guess Who’s Coming to Visit? Long-Term Care Facility Inspections

September 4, 2012
Posted In Health Care Law, Medicaid, Medicare, Occupational Safety and Health Administration (“OSHA”), Office of Inspector General of the United States Department of Health and Human Services (OIG), Patient Protection and Affordable Care Act (“ACA”)

Compliance and preparedness are two very real, everyday concerns for long-term care facilities. Not only are these important aspects of daily operations for the safety of the employees and patients, they are paramount because any day a visitor from the Office of the Inspector General (OIG”) or Occupational Safety and Health Administration (“OSHA”) could show up for an inspection.  Is your facility prepared? More >

Tags: Health Care Law

Compliance Plan – A Provider’s Defense

August 27, 2012
Posted In Abuse and Waste, Affordable Care Act, Department of Health and Human Services (HHS), Health Care Fraud, Health Care Fraud and Abuse Control Program, Health Care Law, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG), Patient Protection and Affordable Care Act (“ACA”)

The Office of the Inspector General (“OIG”) has always encouraged Medicare and Medicaid providers to implement a compliance program. For 14 years, as a matter of fact, OIG has provided compliance guidance in 11 healthcare sectors (including: hospitals, nursing facilities, home healthcare, hospice and third-party billers). With the passing of the Patient Protection and Affordable Care Act (“PPACA”), compliance plans and programs are now mandatory for any provider enrolled in a Federal health care program, including Medicare. More >

Tags: Health Care Law

Fraud, Waste and Abuse Controls Under The Affordable Care Act

August 20, 2012
Posted In Abuse and Waste, Affordable Care Act, Department of Health and Human Services (HHS), Health Care Fraud, Health Care Fraud and Abuse Control Program, Health Care Law, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

The Affordable Care Act (“ACA”) strives to improve our health care system in three main areas; by expanding consumer protections, strengthening Medicare and reducing health care costs.  One key way the government hopes to achieve these goals is through tougher fraud and waste controls. Given the focus on prevention, penalty and recovery, compliance plans are of the utmost importance for all health care providers. First we examine all of the elements incorporated in the ACA that pertain to fraud, abuse and waste before we can begin to develop a compliance plan for our facilities. The new law contains a host of tools aimed at enforcing fraud and waste prevention.  Let’s review: 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

Supreme Court Decision Legitimizes Accountable Care Organizations

August 9, 2012
Posted In Accountable Care Organizations (“ACO”), Affordable Care Act, Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

With its decision upholding the Affordable Care Act, the Supreme Court has authorized the use of Accountable Care Organizations (“ACO”) as one of the principal tools for addressing health care costs and improving care.  When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely by reducing the rate of growth in the cost of health care, the ACO will share in the savings it achieves for the Medicare program.  The Centers for Medicare and Medicaid Services (“CMS”) announced the selection of 88 ACOs to participate in the first round of the Medicare Shared Savings Program. These ACOs will take responsibility for coordinating care for nearly 1.2 million Medicare beneficiaries in 40 states. Three ACOs have been approved for Kentucky and include Quality Independent Physicians (Louisville), Southern Kentucky Health Care Alliance (Smithsgrove), and Deaconess Care Integration (Serving Indiana and Kentucky). In late July, CMS announced 15 new ACOs to participate in the Advance Payment ACO Model Program including Jackson Purchase Medical Association PSC, which is an ACO that includes 6 physician practices in Paducah and Ballard County Kentucky that covers 6000 Medicare beneficiaries. This brings the total participation in the program to 20.   With the 32 systems approved to participate in the Pioneer ACOs Program in February 2012, CMS announced there are now 153 organizations participating in Medicare Shared Savings initiatives, serving over 2.4 million beneficiaries. 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
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