CMS Invites Providers to Assist with Testing and Developing of Bundled Payments Initiative

Currently, Medicare issues separate payments to providers for services furnished to Medicare beneficiaries, with payment based on how much a provider does, not the quality of care provided. The goal of the bundled payment initiative is to link payments for multiple services patients received during an episode of care.

Basically, instead of the individual providers involved whose services were utilized during the episode of care filing separate claims and receiving separate payments, one entity would file the claim for all the services and a “bundled payment” would be received. In turn, the receiving entity would distribute the payment accordingly depending on the model selected.

On August 23, 2011, the Centers for Medicare & Medicaid Services (CMS) welcomed applications from providers to apply to assist with the development of four different bundled payment models. Bundled payments are identified in the Affordable Care Act (ACA) as a method to assist with the improvement of healthcare and lowering costs. ‣ Read more…

Posted on: 28 Aug, 2011          under: Uncategorized

CMS Issues Revised Telemedicine Credentialing Parameters for Hospitals and Critical Access Hospitals

The Centers for Medicare and Medicaid (CMS) published a final rule updating conditions for entities to participate in providing telemedicine services to hospital/critical access hospital patients. (Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital Conditions of Participation: Telemedicine Credentialing and Privileging 76 Fed. Reg. 25550-65 (May 5, 2011)). The Final Rule’s focus is on revamping the previous requirement of having all practitioners providing telemedicine services to undergo the same credentialing and privileging process in order to “embrace new methods and technologies for service delivery that may improve patient access to high quality care.” (p. 25550). ‣ Read more…

Posted on: 18 Aug, 2011          under: Uncategorized

United States Supreme Court Agrees to Hear Case That Addresses Medicaid Providers’ and Program Participants Ability to Sue a State for Payment Cuts

Recently, the United States Supreme Court set October 3, 2011 as the date to hear oral arguments in Douglas v. Santa Rosa Memorial Hospital and Douglas v. California Pharmacists Association. (U.S. Supreme Court No. 09-958). At stake is an individual’s ability to compel states to abide by federal law to provide adequate healthcare to Medicaid recipients.

California made a decision to reduce Medicaid payments to doctors, dentists, pharmacies, adult day health care centers and clinics by 5-10%. In response, a group of medical providers, low-income elderly and disabled individuals challenged the cuts by filing suit. The focus of their argument was whether the State’s actions threatened access to care by Medicaid recipients and violated federal law. By reducing payments, the number of providers currently treating Medicaid patients would decrease and, in turn, Medicaid beneficiaries would not have access to a program they are entitled to. ‣ Read more…

Posted on: 13 Aug, 2011          under: Uncategorized

FASB and the Budget Control Act: Two New Items Potentially Impacting the Revenue Cycle

The first week in August provided two new items healthcare providers need to consider: the Financial Accounting Standards Board’s (FASB) amendments to its healthcare accounting standards, and the Budget Control Act of 2011’s impact on Medicare reimbursement.

FASB’s amendments are targeted at enhancing metrics comparisons. Operating margins, reported growth in revenue, and revenue per admission are all items that are included. Equally as important, bad debt, which includes patient service revenue, will be presented as a contra-revenue instead of an operating expense. In keeping with the disclosure trends of Sarbanes Oxley and Dodd Frank, greater reporting and specificity is required for revenue recognition and bad debt assessment policies. ‣ Read more…

Posted on: 6 Aug, 2011          under: General