Insurance news
SGR Repealed!
Written by Editor   
Tuesday, April 14, 2015 10:01 PM

The sustainable growth rate (SGR) formula is no more. Thanks to new legislation adopted Tuesday April 14.  

In a historic move late Tuesday, the Senate voted 92-8 to permanently repeal the sustainable growth rate (SGR) formula for physician reimbursement under Medicare.  The measure now heads to President Obama, who has said he will sign it.  Medicare patients and their doctors no longer will be threatened by the flawed payment formula that left the Medicare program unstable and threatened access to care.

The U.S. Senate Tuesday evening followed the U.S. House of Representatives’ lead and passed a bill to immediately repeal the SGR formula.

The Medicare Access and CHIP Reauthorization Act was adopted by a vote of 92 to 8 on the eve a 21 percent cut to Medicare payments was set to take place. The vote came a little after 9:30 p.m. Eastern time following several attempts to amend the measure, all of which failed.  

The bill provides positive annual payment updates of 0.5 percent, starting July 1 and lasting through 2019. Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect.

In addition to addressing Medicare payment, the legislation outlines several provisions including:

Read more...
 
Update on the 2015 Medicare Physician Fee Schedule
Tuesday, April 14, 2015 10:25 AM

On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015. In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update.

Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received. CMS will release one day's worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days' worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This "rolling hold" will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.

Read more...
 
Don't Like ICD-10? Don't Worry -- ICD-11 Is on the Horizon
Written by Editor   
Friday, April 10, 2015 12:00 AM

According to the World Health Organization (WHO), which coordinates implementation of the coding system, "ICD is currently under revision, through an ongoing Revision Process, and the release date for ICD-11 is 2017."

Read more...
 
Medicare Fraud Bill Proposed
Written by Editor   
Friday, April 10, 2015 12:00 AM

With all the partisan disputes now happening on Capitol Hill, it's rare to see a bipartisan bill -- especially one that could save the government money.But that's exactly what the Protecting the Integrity of Medicare Act -- otherwise known as H.R. 1021 -- seems to be. The House bill, which does not yet have a companion measure in the Senate, addresses healthcare fraud in the Medicare program in a variety of ways. Among its provisions, the bill would:

Read more...
 
Ethical Concerns Over Referrals Within ACOs
Saturday, March 14, 2015 02:39 PM

Referrals within an Accountable Care Organization can be ethical as long as their selection is influenced in a manner that is transparent, with appropriate metrics and the right incentives,

Some ACOs are creating incentives for patients to seek specialty care inside their organization. Such influencing of referrals raises ethical concerns. ACOs can influence referrals in an ethical manner that enhances choice and improves patient outcomes if three issues are considered: transparency, appropriate metrics, and correct incentives.

Read more...
 
<< first < Prev 1 2 3 4 5 6 7 8 9 10 Next > last >>

Page 7 of 19