Wednesday, April 30, 2014
Tuesday, April 29, 2014
Monday, April 28, 2014
Sunday, April 27, 2014
Thursday, April 24, 2014
Wednesday, April 23, 2014
Audit Contractors Unlikely to Duplicate 2013 Medicare Recovery Haul Amid Dispute
Audit Contractors Unlikely to Duplicate 2013 Medicare Recovery Haul Amid Dispute
By Kerry Young, CQ HealthBeat Associate Editor
Recovery audit contractors successfully challenged about $3.7 billion in questionable Medicare payments in fiscal 2013, a success rate they’re unlikely to duplicate any time soon due to constraints Congress imposed on the industry.
The fiscal 2013 results marked a gain of about 60 percent, compared to the $2.3 billion recovered for Medicare in the previous year, according to an April Department
“At the end of fiscal year 2013, the Recovery Audit Contractor program was returning over $1 billion per quarter to the Medicare Trust Fund,” said Rebecca Reeves, a spokeswoman for the American Coalition for Healthcare Claims Integrity, which represents these auditing firms, in a statement. “The recent constraints place on the RAC program will dramatically reduce this pace.”
Hospitals, the main target of the contractors, have since succeeded in getting Congress to at least temporarily rein in these firms. A “doc fix” bill (PL 113-93) largely sidelined the contractors through March 2015. Intended primarily to stop a mandated cut in doctors’ pay, the measure also would delay some enforcement of a controversial two-midnight rule on hospital stays used to assess whether Medicare admissions were legitimate.
Hospitals have been fighting the policy, saying they could absorb significant losses if auditors successfully challenge decisions to admit patients for stays lasting less than two days (See CQ HealthBeat, Feb. 7, 2014 ). The American Hospital Association last week said that it filed two related lawsuits against HHS challenging the two-midnight rule. The actions contend that provisions in the Centers for Medicare & Medicaid Services’ final inpatient prospective payment rule for 2014 “burden hospitals with unlawful arbitrary standards and documentation requirements and deprive hospitals of proper Medicare reimbursement for caring for patients.”
Seeking to address disputes between the contractors and the hospitals on what constitutes an appropriate inpatient stay, CMS last year put forward a new test for deciding this question. To be considered an inpatient stay, the admitting physician must expect that the patient will need care in the hospital for a period spanning at least two midnights.
The hospital trade group contends that CMS’s own data show that many conditions, including heart attacks, concussions and even “comas without complications” and surgeries such as appendectomies and mastectomies routinely involve short stays that don’t span two midnights. The hospital group said that the two-midnight standard “defies common sense.”
“The word ‘inpatient’ simply doesn’t mean ‘a person who stays in the hospital until Day 3,’ and CMS is not at liberty to change the meaning of words to save money,” the association said in its legal filing.
Hospitals have much to lose. Medicare generally pays them more if a patient is considered admitted and thus qualifies for the federal health program’s Part A payments. Part B is in general intended for payment for outpatient care.
“(T)ypically, years later— a RAC will overrule the physician’s decision to admit the patient on the ground that, in the RAC’s opinion, the patient could have been treated in the outpatient setting, and as a result, CMS will take back the entire Part A payment amount,” the hospital association said in its legal brief, which was filed in the U.S. District Court for the District of Columbia.
While Congress may not address the rule or other health policy in the months ahead, lawmakers have shown interest in the issue. Rep. Sam Graves, R-Mo., has at least 111 Republican and 93 Democratic backers for a bill (HR 1250) that would add new requirements on the contractors. The bill, first introduced in March 2013, has been attracting support at a steady pace since, gaining eight new cosponsors last month. The measure also would also provide the hospitals with potential aid, such as a provision requiring that a physician review each claim denial of a claim for medical necessity made by an employee of the contractor who is not a physician.
But the recovery audit contractors do have support from groups such as Citizens Against Government Waste, which has blasted Graves ’ bill.
“Perhaps unsurprisingly, the success of recovery auditors in particular has raised hackles among providers, particularly hospitals, whose claims constituted the vast majority (88 percent) of the overpayments identified by the RACs. Even though the hospitals were not entitled to the money in the first place, they have called RACs `bounty hunters,’ complaining that their contingency fee compensation model pushes them to be exceedingly aggressive in challenging claims,” the group said in its statement about the Graves bill.
Tuesday, April 22, 2014
Monday, April 21, 2014
Thursday, April 17, 2014
Wednesday, April 16, 2014
Tuesday, April 15, 2014
Monday, April 14, 2014
Register Today for 2014 Rural Surgery Symposium, May 9-10
Register Today for 2014 Rural Surgery Symposium, May 9-10
Attendance space is limited for the 2014 Rural Surgery Symposium, May 9–10, at the American College of Surgeons (ACS) headquarters in Chicago, IL. The symposium will address issues that affect rural surgery, trends in rural surgery practice, and ACS resources for rural surgeons. Tyler G. Hughes, MD, FACS, an ACS Governor from McPherson, KS, and Chair of the ACS Advisory Council for Rural Surgery, McPherson, KS; and David C. Borgstrom, MD, FACS, a Member of the Advisory Council for Rural Surgery, from Cooperstown, NY, are the Symposium Directors.
Symposium topics will include the following:
• Rural Health Care Systems—Surgical Perspective
• Benign Liver Lesions—Practical Surgical Management
• Rural Cancer Care
• The Economic Impact of a General Surgeon to a Rural Community
• Emergency Medical Treatment and Labor Act, Stark Law, Critical Access Hospitals—What You Need to Know
• Unusual Cases from the Frontier—“Stump the Chumps” (Symposium participants should bring a case study to share for a panel discussion.)
• Rural Health Care Systems—Surgical Perspective
• Benign Liver Lesions—Practical Surgical Management
• Rural Cancer Care
• The Economic Impact of a General Surgeon to a Rural Community
• Emergency Medical Treatment and Labor Act, Stark Law, Critical Access Hospitals—What You Need to Know
• Unusual Cases from the Frontier—“Stump the Chumps” (Symposium participants should bring a case study to share for a panel discussion.)
To register online, go to the ACS website.
Sunday, April 13, 2014
Thursday, April 10, 2014
Tuesday, April 8, 2014
Monday, April 7, 2014
CMS to Disclose Individual Physician Payment Data
CMS to Disclose Individual Physician Payment Data
On April 2, the Centers for Medicare & Medicaid Services (CMS) announced its plans to release data on or after April 9 to the public on Medicare payments to physicians. The data will list procedures performed by 880,000 individual physicians, along with how much they charged and how much Medicare reimbursed the physicians in 2012. Although CMS will not release personally identifiable information about patients, the data will be organized by physicians’ National Provider Identifier, Health Care Common Procedure Coding System code, and place of service. CMS indicated in a letter that it weighed the privacy interest of physicians against the public’s interest in shedding light on government activity and operations, and determined that the public’s interest outweighs the physicians’ privacy interests. CMS also indicated in a blog post that these data will allow a wide range of analyses that compare 6,000 different types of services and procedures provided and will allow consumers to compare the services provided and payments received by individual health care providers. The American College of Surgeons will monitor the impact of this data release and will analyze any consequences for surgeons.
Friday, April 4, 2014
Wednesday, April 2, 2014
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