Friday, April 18, 2014

Enrollment in Health Insurance Reaches Surges to 8 Million

The Obama Administration released data showing that over the last six weeks a surge of 3.8 million Americans enrolled in private healthcare plans. That notable when compared to the 4.2 million individuals that signed up in the entire first five months after enrollment when the website was plagued with IT issues that impaired enrollment. The Administration explained that young adults comprise more than a quarter of the enrollees.

During the press conference President Obama emphasized that there are 5 million more people that would be eligible for health insurance in states that chose not to expand Medicaid. Leaders in those states commented that they were concerned about costs if Congress failed to maintain full federal funding as the law requires. 

Thursday, April 10, 2014

ICD-10 Deadline Delay Slows Medical Billing Conversion

Medical billing codes are used by doctors, hospitals, and health insurance companies to track each patient procedure and ensure that the doctors are paid. The ICD-9 code has been in place since the 1970s. The ICD-9 was scheduled to be replaced with ICD-10 by October 2014. 

The conversion would add tens of thousands of unique codes to the medical billing structure, an increase to roughly 72,000 codes in ICD-10 from about 4,000 codes in ICD-9. Advocates for ICD-10 argue that the new coding system is necessary to modernize the billing code to capture the variety of medical treatments available now that did not exist in the 19070s.  Additionally, they argue that a more detailed code will allow for more precise medical research and data collection. 

Despite the benefits of moving to an ICD-10 medical billing system, the transition over the last five years has been difficult. In order for the transition to be smooth and successful all parties need to switch to the ICD-10 codes at the same time. Many smaller practices were not able to dedicate the training time and resources to complete the transition by October of this year. 

However, larger facilities, hospitals, and insurance companies with more resources were able to dedicate time and money to implementation measures and preparation. In fact, many have spent millions to train staff on the new ICD-10 billing codes. These facilities were relying on the statements by Health and Human Services representatives made as late as February 2014 that explained the October compliance date was firm. Questions remain about the implementation of ICD-10 at these facilities and whether these employees will need to be re-trained as the adjusted ICD-10 deadline nears.

Friday, April 4, 2014

Congress Passes Bill to Delay Medicare Reimbursement Cuts

On Monday evening the Senate passed and President Obama signed the Protecting Access to Medicare Act of 2014 (H.R. 4302) into law. This marks the 17th time Congress delayed the cuts to physician reimbursements established with the Sustainable Growth Rate under Medicare. The bill delays a 24% cut to the payments.

The Senate passed the bill with a 64-35 vote the evening the cuts were to go into effect at midnight. The Senate vote was preceded by the House passing the bill with a rare voice vote last week.  Both chambers moved quickly to pass this bill after it became obvious no agreement would be reached on how to pay for the permanent 'doc fix' bills.  

The Sustainable Growth Grate (SGR) was created in 1997 by Congress as a mechanism for tracking the payments with economic growth. The SGR became a problem within a few years as increases in healthcare costs substantially outpaced economic growth. This development resulted in the creation of a multi-billion dollar shortfall for the funding of Medicare payments to physicians. 

Members on both sides of the aisle and in both Chambers spoke about the need to permanently fix the SGR. However, they recognized the immediate need to prevent the delay's expiration and prioritized this temporary patch over a lengthy negotiation process to pass a  permanent fix that would result in the expiration of the SGR delay. 

Thursday, March 27, 2014

Bill to Delay ICD-10 and Sustainable Growth Rate Patch Passes House

Advocates on behalf of hospitals and practitioners were optimistic about the likelihood of a permanent 'fix' to the Sustainable Growth Rate for Medicare's physician reimbursement system. Members in both the House and the Senate introduced bills this session that would repeal the Sustainable Growth Rate in Medicare's physician payment formula. 

In a surprise development today the House passed the Protecting Access to Medicare Act of 2014, H.R. 4302, by voice vote. This bill does not provide a permanent fix, only a one year patch to the Sustainable Growth Rate. The legislation, sponsored by Rep. Pitts of Pennsylvania, did not extend a fix for the SGR to physician-owned hospitals. Insiders agree that the cost of longer term bipartisan bills with permanent fixes to SGR were tabled because the parties were not able to agree on how to pay for the costs--about $140 billion over a 10 year period.  

Many on the hill expect the Senate to move this bill to a vote tonight. Speaker Harry Reid is said to be working on a deal to bring the bill to the floor. However, Senator Wyden is said to be pushing back on passing a bill with only a short term fix. Stakeholders following SGR legislation believe that if a temporary fix is passed the Congress will feel less pressure, and efforts to pass a permanent fix this year will fade into the background. 

The Protecting Access to Medicare Act of 2014 also contains a provision to delay the ICD-10 meaningful use requirements until October 2015. CMS Administrator Marilyn Tavenner has repeatedly stated that the agency was not going to extend the ICD-10 meaningful use requirements. Many eligible practitioners and hospitals are concerned about being able to meet the deadline and have publicly appealed to the agency and Congress to extend the compliance deadline. 

Tuesday, March 18, 2014

More than 10,000 Electronic Health Records at Risk in Data Breach

Service Coordination notified nearly 14,000 Maryland residents this month that their personal medical information may have been compromised. Service Coordination is a state-licensed nonprofit organization based in Frederick, Maryland, that works with Maryland residents with intellectual and developmental disabilities. Service Coordination is one of five organizations licensed to provide services by Maryland's Developmental Disabilities Administration. To date there have been no reports of breaches from the other four licensed organizations. 

The organization learned of the security breach in October of 2013, but delayed notifying affected individuals at the request of the U.S. Justice Department. The Justice Department requested the delay to allow time for an unhindered federal investigation. The investigation resulted in the identification of the alleged hacker and the seizure of the hacker's equipment and accounts. 

To date there is no evidence that the data has been released or used for nefarious purposes. Service Coordination spokesman, Michael Baisey, explained that the breach involved a single document that contained personal information for nearly 70% of the group's 13,900 clients. Service Coordination will assist clients and families with credit report checks and identity theft protection. 

Wednesday, March 12, 2014

Polls Show Number of Uninsured Adults Lowest Since Obama Took Office

The deadline to enroll on the new insurance exchanges is quickly approaching, with just three weeks remaining. The deadline seems to be spurring a dramatic up-tick in the number of adults enrolling in health insurance plans. Acording to the Gallup-Healthways Well-Being Index released Monday the number of Americans with no health insurance has dropped to the lowest levels since President Obama was sworn in. The index found that the percent of uninsured adults dropped from 17.1-percent in the last quarter of 2013 to 15.9-percent in 2014. Experts attribute the increasing number of insured adults to the insurance plans made available by the Affordable Care Act.

The increase in enrollment was found across all demographic groups examined by the index. Hoewver, enrollment throughout the Latino demographic lagged behind other demographic groups. This is notable because the Obama Administration is actively reaching out to the relatively young Hispanic community to encourage enrollment. 

A significant drop in the rate of uninsured adults occurred among African-Americans with a 2.6 percentage point decline. The rate declined 1percentage point among white adults, but only eight-tenths of a percentage point for Latinos. The largest drop in the uninsured rate was a 2.8 percentage point difference for households with an annual income of less than $36,000.

CMS Issues Guidance on Stage 2 Meaningful Use Hardship Exceptions

The Centers for Medicare and Medicaid Services (CMS) issued guidance on qualifying for the hardship exception from Stage 2 meaningful use requirements under the federal electronic health record incentive payment program. CMS has been under pressure by stakeholders and lawmakers alike to provide clarification about how to apply and what conditions qualified hospitals and eligible professionals for a hardship exemption

The guidance explains that CMS may grant hospitals and eligible professionals the hardship exception and grant an extension for meeting the Stage 2 meaningful use requirements if their electronic health record (EHR) vendor is at fault for their failure to meet the deadline. This expands on previous statements by CMS Administrator Marilyn Tavenner that the applications for exceptions would be evaluated on a case-by-case basis. 

The guidance specifically states that providers may apply for hardship exceptions if the "EHR vendor was unable to obtain 2014 certification" or the hospital or eligible professional "was unable to implement meaningful use due to 2014 EHR certification delays." If approved, the hardship exception is valid for a single payment year. In the event the application for exception is denied hospitals and eligible professionals may not appeal the decision and any denial is considered final.

The hardship exception application for hospitals is available here.

The hardship exception application for eligible professionals is available here