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Policy

 

Days after CMS first issued policy guidance on how states could require “able-bodied” Medicaid beneficiaries to work or face losing their coverage, Kentucky has become the first with an approved waiver to test out those requirements.

Major healthcare associations had a decidedly mixed reaction to the Medicare Payment Advisory Commission (MedPAC) recommending to Congress that the Merit-based Incentive Payment System (MIPS) be eliminated, with some stakeholders saying such a major change would be premature less than three years after the Medicare Access and CHIP Reauthorization Act (MACRA) was passed.

Full-year quality reporting will be required in the Merit-based Incentive Payment System (MIPS) for the first time in 2018, but clinicians haven’t received word from CMS on whether they’re eligible to participate, according to the Medical Group Management Association (MGMA).

Following up on criticisms of the Merit-based Incentive Payment System (MIPS) at recent meetings, the Medicare Payment Advisory Commission (MedPAC) formally voted to recommend scrapping the payment system, arguing the program replicates flaws from those it was meant to replace.

CMS has released guidance for how states can seek Medicaid waivers imposing requirements for beneficiaries to work in order to receive coverage, a move which some healthcare groups quickly condemned and threatened to sue in order to stop.

 

Recent Headlines

OIG to Look For Additional Kwashiorkor Fraudulent Billing in 2014

The 2014 Office of Inspector General (OIG) Workplan promises that the agency will look for more cases of hospitals miscoding malnutrition cases in Medicare patients as cases of kwashiorkor. Already this year, the agency has reached settlements with Mercy Medical Center, in Des Moines, Iowa, and Christus Saint Vincent Regional Medical Center, in Santa Fe, N.M., over incorrect billing for kwashiorkor in a combined total of 217 patients who actually did not have the disease.

5 Things the SGR Bill Does Besides Fix Doc Pay

The H.R. 4015/S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014, bills also contain provisions that impact more than just physician pay. Among the provisions tucked inside the bill are these five.

CMS Resets Clock on 2-Midnight Rule

A Centers for Medicare and Medicaid Services (CMS) decision to delay the date when Recovery Audit Contractors (RACs) will start looking for inpatient claims that should have been billed as outpatient observation because of their short duration (less than a day defined as two midnights in the hospital) will buy hospitals and the groups that represent them time to fight CMS-1599-F (commonly known as the “2-Midnight Rule”).

HHS Gives Patients Direct Access to Lab Results

The U.S. Department of Health and Human Services (HHS) has amended rules covering how laboratory test results are communicated to patients to allow patients to skip going through their physician to get access to their test results.

ACA Preparedness: How to Conduct a Community Health Needs Assessment

Non-profit hospitals have to do it every three years to comply with the requirements of the federal Patient Protection and Affordable Care Act (ACA), but probably any hospital or clinic would benefit by conducting a Community Health Needs Assessment (CHNA).

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