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Healthcare News

 

Survey: Maintaining provider directories costs docs $2.7B a year due to influx of requests

11/18/2019


(FierceHealthcare)
Physician offices are being weighed down by maintaining provider directories, costing them a full staff day a week and an average cost of nearly $1,000 a month, a new survey found.


The cause of the problem is requirements from payers on how providers must submit directory information, such as via software, phone or fax, according to a recent survey by Council for Affordable Quality Healthcare, an insurance industry group. Overall the cost of directory maintenance for U.S. physicians was estimated to be $2.7 billion a year.


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CMS: Medicare improper payment rate fell as new fraud prevention efforts take hold

11/18/2019


(FierceHealthcare)
The Medicare improper payment rate for fee-for-service fell to the lowest level since 2010, a feat the Trump administration claims is due to aggressive fraud measures.


The improper payment rate for federal fiscal year 2019 was 7.25%, a decrease from 8.12% in fiscal year 2018, according to a release from the Centers for Medicare & Medicaid Services (CMS) Monday. This is the third consecutive year that the improper payment rate for fee-for-service payments fell below 10%.


“Every dollar spent inappropriately is one that should have been used to benefit patients,” said CMS Administrator Seema Verma in a statement. “Under President Trump’s leadership, CMS is pulling every lever at its disposal to safeguard precious resources and direct them to those who truly need them.”


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Hospitals get ready to fight CMS in court again, this time over transparency

11/15/2019


(FierceHealthcare)
Hospitals are already getting ready to sue over the Trump administration's transparency rule just a few hours after its release.


The final rule released Friday by the Centers for Medicare & Medicaid Services (CMS) will require hospitals to post in a searchable format payer-negotiated rates for 300 shoppable services starting in 2021 and to post raw data for all of its payer-negotiated rates. The agency also proposed a rule to require insurers to divulge real-time cost-sharing and rates for in- and out-of-network charges from providers.


“The fact is that this regulation exceeds the administration’s authority, and we plan on joining with hospitals to file a legal challenge,” said Federation of American Hospitals President and CEO Chip Kahn in a statement.


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HealthCare.gov sign-ups down in 2nd week of ACA open enrollment

11/14/2019


(FierceHealthcare)
The number of people who signed up for Affordable Care Act (ACA) coverage on HealthCare.gov in the second week of open enrollment declined compared to the same time period in 2018.


Enrollment figures released Wednesday from the Centers for Medicare & Medicaid Services (CMS) showed that 754,967 people signed up for the second week of open enrollment, a 6% decline compared to the 804,556 that signed up in 2018.


From Nov. 1 to Nov. 9, HealthCare.gov saw 932,049 sign up for insurance for the 2020 coverage year. But while sign-ups overall are slightly down, there are signs of optimism in the latest data delivered by CMS.


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Experts: Transparency key to avoid controversy generated by Google-Ascension data deal

11/13/2019


(FierceHealthcare)
As payers and providers seek out tech giants to move their health data to the cloud, experts warn that they need to be more transparent after a secret deal between Google and Ascension generated controversy.


The Wall Street Journal reported earlier this week that Ascension, the second largest U.S. healthcare system, made an unannounced deal with Google to move Ascension’s detailed health information on more than 50 million patients to Google’s cloud computing system. But the deal has sparked major concern about privacy from advocates and lawmakers who note that Google is currently under a consent decree for major privacy violations.


However, experts say that the deal itself appears to be perfectly legal under the Health Insurance Portability and Accountability Act (HIPAA), the law that protects patient data.


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CMS seeks to crack down on schemes used by states to get higher federal match in Medicaid

11/12/2019


(FierceHealthcare)
The Trump administration issued a proposed rule to clamp down on schemes that enable states to get higher federal Medicaid payments.


The rule from the Centers for Medicare & Medicaid Services released Tuesday is intended to enable the agency to better monitor and enforce requirements surrounding state Medicaid expenditures. The proposal comes after calls from oversight organizations and Congress for greater transparency for state Medicaid supplemental payments.


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Voters say Congress needs to curb drug prices, but are lawmakers listening?

11/11/2019


(FierceHealthcare)
House Democrats are poised to pass sweeping legislation to lower drug prices using strategies President Donald Trump has endorsed. A Trump aide urged the Republican-controlled Senate to vote on a different package curbing drug prices that was drafted by a senior Republican.


But at least right now, neither measure appears likely to attract enough bipartisan support to become law.


Nearly 8 in 10 Americans say the cost of prescription drugs is unreasonable, with voters from both parties agreeing that reducing the cost of prescription drugs should be one of Congress’ top priorities, according to a poll last month by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)


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CMS: Part B premiums, deductibles to rise in 2020

11/8/2019


(FierceHealthcare)
Premiums and deductibles for Medicare Part B are set to increase in 2020, the Trump administration announced Friday.


The Centers for Medicare & Medicaid Services (CMS) released information on cost sharing for traditional Medicare and Part B and said that the rising costs in Part B are associated with rising spending on physician-administered drugs. The standard monthly premium in Part B for 2020 will be $144.60, $9.10 higher than in 2019.


Deductibles are set to rise from $185 in 2019 to $198 in 2020, CMS said.


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MedPAC: Lack of site-neutral payments driving physician-hospital mergers

11/7/2019


(FierceHealthcare)
Medicare’s payment policy is a major driver of physicians linking up with hospitals, a trend that is raising costs for beneficiaries, new data show.


The data from the Medicare Payment Advisory Commission examined the rate of consolidation and the reasons behind it. The findings released during MedPAC’s meeting Thursday will be part of a report that was requested by Congress in 2018 on physician and hospital consolidation.


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Industry Voices—5 steps to address prior authorization burdens and improve patient care

11/6/2019


(FierceHealthcare)
The requirement that physicians get prior authorization from insurers before providing a medical service, diagnostic test or medication may be the greatest single bottleneck for the delivery of quality healthcare.


Consider, for example, that the majority of authorizations still happen via manual submission of the request and supporting clinical documentation via fax or phone. Or that rather than getting approval for all that would be needed for a knee replacement—the device, pre-op and post-op visits, crutches, pain medication and physical therapy— in one bundle, in many cases approvals need to be sought for each individual item or service.


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