Noteworthy News

Archive for June, 2013


Progress Slow on Enhanced Primary Care Payments

States are having a difficult time making the enhanced Medicaid payments for primary care providers mandated by the Affordable Care Act. According to MACPAC, the Medicaid and CHIP Payment and Access Commission, only four states were actually making the enhanced payments by late May. Among the obstacles states are encountering are claims processing challenges; identifying providers eligible for the enhanced payments; and figuring out a way to increase payments to providers contracting with managed care plans. The enhanced primary care payments are required under the Affordable Care Act for calendar years 2013 and 2014.  The purpose of the payments is [&hellip

Senate Committee Gets Earful About RAC Audits

Medicare RAC audits cost hospitals a great deal of money and often are unfair, hospital executives told the Senate Finance Committee at a recent committee hearing. Among other problems caused by audits performed under Medicare’s RAC (Recovery Audit Contractors) program, according to hospital officials, they too often deny payments for inpatient services; they leave hospitals feeling forced to hold for observation status patients they believe should be admitted as inpatients; and they cost hospitals significant amounts of staff time and money to prepare for, defend, and appeal decisions with which they disagree. RAC audits also often leave Medicare patients with [&hellip

NAUH Proposes Change to Reduce DSH Cut

In a letter to the Centers for Medicare & Medicaid Services (CMS), the National Association of Urban Hospitals (NAUH) has asked CMS to modify its methodology for reducing the Medicare disproportionate share (Medicare DSH) pool for FY 2014. Under the Affordable Care Act, that Medicare DSH pool is supposed to begin growing smaller in FY 2014 to reflect an expected decrease in the number of uninsured Americans as a result of the reform law’s expanded Medicaid eligibility and insurance subsidies. While CMS was required to use Congressional Budget Office (CBO) estimates for the number of people who will gain insurance, [&hellip

NAUH Comments on Proposed Medicare Regulation

In a letter to the Centers for Medicare & Medicaid Services (CMS), the National Association of Urban Hospitals (NAUH) has commented on Medicare’s proposed FY 2014 inpatient prospective payment system regulation. NAUH’s letter addresses Medicare disproportionate share (Medicare DSH) payments, the coding adjustment for inpatient payments, the outlier threshold, the labor-related share adjustment, the value-based purchasing program, the hospital readmissions reduction program, and graduate medical education. NAUH also proposes its own, detailed formula for recalculating the size of the FY 2014 Medicare DSH pool based on the difference between the calendar year in which the Congressional Budget Office projected the [&hellip

NAUH Lauds MedPAC in News Release

The National Association of Urban Hospitals (NAUH) has praised MedPAC in a news release for the agency’s recommendation for reforming the Medicare hospital readmissions reduction program. That program penalizes hospitals for what it considers “excessive” readmissions of Medicare patients.  MedPAC has observed that basing such penalties simply on numbers, regardless of the types of patients hospitals serve, unfairly penalizes safety-net hospitals that care for patients whose problems often go beyond medical concerns and could eventually discourage hospitals from serving such patients. Instead, MedPAC recommended that in assessing hospitals’ readmissions, Medicare should compare hospitals to similar hospitals – such as comparing [&hellip

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