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CMS Made $93.6M in Incorrect Meaningful Use Payments, OIG Audit Reveals Print E-mail
Written by Rajiv Leventhal | Healthcare Innovation   
Friday, 27 December 2019 17:53

Over a four-year period, the Centers for Medicare & Medicaid Services (CMS) made an estimated $93.6 million in Meaningful Use (MU) incentive payments to eligible professionals who did not comply with federal requirements, according to a new report from the Office of Inspector General (OIG). Going back several years, the federal government has made Medicare payments to acute care and critical access hospitals as an incentive for using electronic health records (EHRs). A prior OIG audit in 2017 revealed that CMS made an estimated $729 million in Medicare EHR incentive payments to eligible professionals who did not comply with federal Meaningful Use requirements. In addition, 17 prior OIG audits of Medicaid EHR incentive payments found that states overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.3 million. According to OIG, an agency within the U.S. Department of Health & Human Services(HHS), these overpayments resulted from inaccuracies in the hospitals' calculations of total incentive payments.

Hospitals sue CMS over price transparency rule Print E-mail
Written by Robert King | Fierce Healthcare   
Thursday, 05 December 2019 00:00

Major hospital groups and several individual facilities have filed a lawsuit charging the Trump administration's price transparency rule is "unlawful, several times over." The federal lawsuit announced Wednesday was widely expected after the Centers for Medicare & Medicaid Services (CMS) finalized the rule last month that requires hospitals to post payer-negotiated rates for 300 shoppable services. Hospitals have balked at the cost of implementing the rule, which goes into effect in 2021, and warn the regulation could harm price competition.

"Hospitals and commercial health insurers keep the rates they privately negotiate confidential for good reason: it would undermine competition if they were required to be disclosed publicly and blunt incentives for health insurers to participate in innovative arrangements," according to the lawsuit.

Expensive Medicare patients aren't who you think Print E-mail
Written by Peter Ubel, MD | KevinMD   
Wednesday, 23 October 2019 18:12

Over half of Medicare spending is concentrated in 10 percent of patients. With Medicare expenditures rising at an unsustainable clip, reigning in the costs of those patients is key to controlling health care spending. So who are those patients and what expenses are they racking up? It's not who or what I expected. When I think of high-cost patients, I envision people with drawn-out hospital stays, or imagine people readmitted to the hospital time and time again for chronic problems. Hospital care is expensive, meaning most of the most expensive patients in any given year have probably experienced a hospital stay or two. Or at least that's what I used to think. But when José Figueroa and colleagues at Harvard looked at Medicare expenditures, they discovered that chronically costly patients didn't become costly because of expensive hospital stays. Instead, it is outpatient expenses that stand out among these patients, including many very high-priced medications. The researchers were focused on identifying patients that weren't only expensive this year, say, but also next year and the next. Chronically expensive patients.

Bankruptcy Court Stops Medicare from Recouping Monies Owed by Provider Print E-mail
Written by Michael P. Gennett   
Saturday, 05 October 2019 14:01

A Delaware Bankruptcy Court Judge has entered an order prohibiting Medicare from withholding payments to a diagnostic testing provider, True Health Diagnostics, LLC, while the bankruptcy case is pending. Prior to filing the bankruptcy case, Medicare identified two large overpayments owed by True Health and also suspended its future payments. The Judge determined that it was not necessary to consider entering an injunction prohibiting Medicare from withholding payment to True Health because the government was already prohibited from doing so under the automatic stay of creditors’ collection efforts that is in effect in every bankruptcy case.

This is potentially a landmark case for Medicare providers that have been forced into insolvency by Medicare audits or payment suspensions because, if upheld on appeal, it may give the provider a mechanism to reinstate Medicare payments to either facilitate restructuring or as leverage to payment suspension that Medicare is unwilling to lift, regardless of the financial impact to the company—an all too common argument that has, historically, fallen on deaf ears within the agency. Recent similar efforts in other non-bankruptcy courts across the country have led to inconsistent decisions, with some courts halting Medicare recovery while others have rejected such efforts by the providers. Attorneys for Medicare immediately appealed the True Health decision, and expect a decision on the in the short term rather than long-term because the case is in bankruptcy court. Providers with large overpayments or payment suspensions should follow this appeal to see whether bankruptcy or the preparations for a restructuring may be used as an offensive strategy where the Centers for Medicare and Medicaid Services is unwilling to consider any alternative remedies other than a payment suspension which effectively cripples the operations of the company. Providers and suppliers, of course, should be mindful of the fact that the strategy should be carefully balanced by other alternative remedies that the agency might pursue including revocation of the company’s provider agreement or supplier number either during or after a plan of confirmation or other actions that the agency might pursue including ongoing payment or pre-payment audits upon the emergence of bankruptcy. Nevertheless, this arrow in the quiver is a tool that should be evaluated.
New Round of Medicare Readmission Penalties Hits 2,583 Hospitals Print E-mail
Written by Jordan Rau | KHN   
Tuesday, 01 October 2019 17:48

Medicare cut payments to 2,583 hospitals Tuesday, continuing the Affordable Care Act's eight-year campaign to financially pressure hospitals into reducing the number of patients who return for a second stay within a month. The severity and broad application of the penalties, which Medicare estimates will cost hospitals $563 million over a year, follows the trend of the past few years. Of the 3,129 general hospitals evaluated in the Hospital Readmission Reduction Program, 83% received a penalty, which will be deducted from each payment for a Medicare patient stay over the fiscal year that begins today. Although Medicare began applying the penalties in 2012, disagreements continue about whether they have improved patient safety. On the positive side, they have encouraged hospitals to focus on how their patients recuperate, and some now assist them in procuring medications and follow-up appointments. But the hospital industry and some academics have raised concerns that some hospitals may be avoiding readmitting patients who require additional inpatient care out of fear of the financial repercussions, while others have said the program is not showing major benefits.

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