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Showing 57 posts in Medicaid.

The Federal Medicaid Apple: Poison or the Cure?

July 30, 2012
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

As the uncertainty about healthcare reform was extinguished by the Supreme Court in its 5-4 decision upholding the Affordable Care Act, with the provision that the Department of Health and Human Services may not withhold Medicaid funding from states that refuse to adopt the Medicaid expansion, all states, including Kentucky, now have important decisions to make about expansion of Medicaid to a projected 22.3 million uninsured eligible individuals.  Under the Affordable Care Act, the federal government will pay the full cost of covering the newly eligible Medicaid participants for three years from 2014 to 2016.  Thereafter the federal share will gradually decline until it reaches 90% in 2020.  For traditional Medicaid, the federal government now pays, on average, about 57% of a state’s total Medicaid costs.  With 826,941 Kentucky Medicaid beneficiaries in January 2012, and an additional 290,000 individuals that would be covered under the expansion, Governor Steve Beshear has announced that he is studying the issues and the costs. More >

Tags: Health Care Law

HOSPITAL PAYMENT FOR PERFORMANCE: DRIVEN BY PHYSICIAN’S QUALITY

April 17, 2012
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Department of Health and Human Services (HHS), Health Care Law, Medicaid, Medicare

As the fate of the Affordable Care Act is being determined by a divisive Supreme Court, the health care industry is being led or possibly dragged by the Department of Health and Human Services (“HHS”) and the Center for Medicare and Medicaid Services (“CMS”) into new payment systems that focus on quality of care, outcomes and individual provider performance rather than the traditional fee for service payment model.  Even if the Supreme Court finds the Affordable Care Act to be unconstitutional, the change from a payment system focused upon individual services to payment focused upon the quality of the care and patient outcomes are being woven into the fabric of the Medicare reimbursement system.  While change in the system is assured, whether the new models will actually bring about better and more efficient care or just reduce available reimbursement is unknown.  Despite the unknown effect of paying for performance based upon quality, CMS is marching on with new programs and payment penalties.  Physicians, whether employed by a hospital or in a private practice, should be aware of how quality is beginning to drive hospital reimbursement as well as the importance of the physician’s role in determining the quality of care provided by hospitals.  By 2017, 6% of all DRG payments will be subject to quality measures through new CMS payment programs for hospital readmissions, value based purchasing and hospital acquired conditions.  With these new programs determining a significant amount of payment, physicians must understand the programs and direct their services accordingly.  Likewise, hospitals must develop ways to compensate physicians for providing high quality care in a manner that allows hospitals to earn performance payments. More >

Tags: Health Care Law

CMS Has Issued Proposed Rule Which Would Force Providers to Report Overpayments in 60 Days

March 7, 2012
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

The Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations on Tuesday, February 14, 2012 proposing that providers and suppliers must report any self-identified overpayments within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is the latter. More >

Tags: False Claims Act, Health Care Law

ON THE ENFORCEMENT RADAR: MEDICAID AUDITS AND THE 2012 OIG WORK PLAN

February 9, 2012
Posted In Health Care Law, Kentucky’s Department for Medicaid Services, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

Unlike the Department of Health and Human Services Office of Inspector General (“OIG”) which publishes a Work Plan each year, the Department of Medicaid Services (“Medicaid”) generally does not publish guidance on the areas which it plans to investigate and/or audit. In fact, Medicaid’s website states … “Medicaid does not provide guidance on how companies should bill for services, but will direct you to applicable regulations.  If you receive direction from staff about how to bill, the Department will not be bound by such instruction, unless it was given by a Director or Commissioner.” Because the federal integrity programs are now moving through the process, Kentucky Medicaid providers are starting to see lots of audit activities. Unlike the OIG audits, we don’t know the precise subject matter of the Medicaid audits, but the process for appeal is outlined below in addition to the areas announced for review by the OIG. More >

Tags: Health Care Law

ON THE ENFORCEMENT RADAR: THE 2012 OIG WORK PLAN

January 30, 2012
Posted In Health Care Law, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

The Office of Inspector General of the United States Department of Health and Human Services (OIG) released its Work Plan for fiscal year 2012.  At the beginning of each fiscal year, the OIG issues its annual Work Plan, which describes current audit, enforcement and evaluation activities and those the agency plans to initiate in the upcoming year.  The Work Plan also provides a general view of the OIG’s investigative, enforcement and compliance activities.  Basically, the Work Plan informs health care providers what is on the OIG’s enforcement radar in the coming year.  Physicians should know what areas that the OIG is concerned about and review their own practices to ensure compliance with regulatory requirements.  The following are some of the highlights from the FY 2012 Work Plan. More >

Tags: Health Care Law

Courier Journal publishes online prescription database

January 26, 2012
Posted In Health Care Law, Kentucky Board of Medical Licensure, Kentucky’s Department for Medicaid Services, Medicaid

The Courier Journal recently published an online database allowing the public to search, by prescriber last name or zip code, the number of prescriptions Kentucky doctors and other prescribers wrote between 2001 and 2011 for seven commonly-abused drugs: alprazolam, diazepam, morphine, methadone, fentanyl, oxycodone and hydrocodone. The newspaper accessed information from Kentucky’s Department for Medicaid Services via the Open Records Law, so the database is limited to Medicaid claims data. As Senator Grassley (R-IA) and other senators raise concerns that over-prescribing may constitute fraud and abuse, it is important for Kentucky physicians and prescribers to comply with compliance plans, state and federal laws, as well as Kentucky Board of Medical Licensure guidelines. More >

Tags: Health Care Law
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