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Archive for March, 2015

Reports Issued on Hospital Uncompensated Care Costs and Medicaid Expansion

Monday, March 23rd, 2015

According to a report issued by the Department of Health and Human Services (HHS), hospital uncompensated care costs in 2014 were $7.4 billion lower because of gains in health insurance coverage under the Affordable Care Act (ACA).  More than $5 billion of the estimated reduction was in states opting to expand Medicaid to uninsured low-income adults. A second HHS report looks at the economic impact of Medicaid expansion, including jobs and federal funding. The report includes a summary of state-specific impacts for 26 states that commissioned independent studies.

The reports can be found by going to http://aspe.hhs.gov/health/reports/2015/MedicaidExpansion/ib_UncompensatedCare.pdf and


Sequestration to Continue Through March 31, 2016

Tuesday, March 17th, 2015

For the Medicare Fee-For-Service (FFS) program, claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a two percent reduction in Medicare payment through March 31, 2016. Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), including claims under the DMEPOS Competitive Bidding Program, will continue to be reduced by two percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment will continue to be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

Although beneficiary payments for deductibles and coinsurance are not subject to the two percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the two percent reduction. The Centers for Medicare & Medicaid Services (CMS) is encouraging Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to continue discussions with beneficiaries on the impact of sequestration on Medicare’s reimbursement.

More information can be found at http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~95XLW67354?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email

Next Generation ACO Model Announced by CMS

Tuesday, March 10th, 2015

On March 10, the Centers for Medicare & Medicaid Services (CMS) announced its Next Generation Accountable Care Organization (ACO) Model. According to CMS, the Next Generation ACO Model will be added to its existing portfolio of ACO models, which are the Medicare Shared Savings Program, the Pioneer ACO Model, the Advance Payment ACO Model, the ACO Investment Model, and the Comprehensive End Stage Renal Disease (ESRD) Care Initiative. The new model is intended for ACOs that are experienced in coordinating care for populations of patients, and will allow them to assume higher levels of financial risk and reward than under the Pioneer Model and Shared Savings Program. The agency expects from 15 to 20 ACOs to participate in the new model.

The fact sheet is available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-03-10.html