GAO: Differences in Medicare Contractor Requirements Exacerbate Provider Burden, Inefficiencies
The Government Accountability Office (GAO) has issued a new report highlighting the numerous and varied requirements of Medicare’s contractors for post-payment review, including Medicare Administrative Contractors (MACs); Zone Program Integrity Contractors (ZPICs); Recovery Auditors (RA); and Comprehensive Error Rate Testing (CERT) contractors.
The report, entitled “Medicare Program Integrity: Increasing Consistency of Contractor Requirements May Improve Administrative Efficiency,” found that the extent of CMS’ requirements for the four types of Medicare contractors vary widely,
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CMS Addresses Overpayments for Services Provided to Incarcerated Beneficiaries
The Centers for Medicare and Medicaid Services has released a document providing an update on Medicare demand letters and Medicare claim cancellations associated with an item or service provided to incarcerated beneficiaries.
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Health Reform’s Network Adequacy Standards: New Report, Hill Day Session Announced
The extent to which healthcare services are available to millions of Americans purchasing health insurance through state-based marketplaces under health reform will depend in large part on the adequacy of their health plans’ provider networks. A new report issued by the Robert Wood Johnson Foundation (RWJF) in partnership with the Georgetown University Health Policy Institute sheds light on how states are managing network adequacy issues.
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Get Covered America to Hold National Day of Action September 7; Register for CMS Enrollment Webinars
On September 7, groups around the country will host events as part of Get Covered America’s National Day of Action. Get Covered America is a nonprofit, nonpartisan campaign of Enroll America focused on raising public awareness and engaging consumers about the new health insurance available under the Affordable Care Act (ACA).
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Obama Administration Delays Cap on Out-of-Pocket Costs for Some Insurers
Some consumers will not benefit from the health reform law’s caps on out-of-pocket spending until 2015, according to a policy change made quietly by the Obama Administration in February.
The Affordable Care Act contains a number of provisions designed to protect health insurance consumers from catastrophic costs, including a cap on out-of-pocket expenses. Beginning in 2014, the law limits annual deductibles, copayments, and other types of cost sharing to no more than $6,350 for an individual and $12,700 for a family.
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Making Sense Of Premium Rates In Insurance Marketplaces
One of the biggest questions around the Affordable Care Act’s upcoming coverage expansions is whether the new state-based insurance marketplaces will result in higher or lower premiums for consumers than the options now available to them. Critics of the health law have speculated that the law’s new requirements on insurance products will lead to skyrocketing premiums, while supporters have argued that greater transparency and competition among insurers will lead to big savings for consumers.
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House Votes to Block IRS from Enforcing Health Reform
In its last action before a five-week summer recess, the House voted late last week to prohibit the Internal Revenue Service (IRS) from enforcing or carrying out any provision of the Affordable Care Act. Approved in a largely party-line 232-185 vote, the bill, dubbed “Keep the IRS Off Your Health Care Act” (H.R. 2009) now goes to the Senate, where it has virtually no chance of approval.
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House Committee Unanimously Approves Medicare Physician Pay Reform
The House Energy & Commerce Committee this week unanimously passed legislation to reform and repeal the Medicare physician Sustainable Growth Rate (SGR) formula. This formula requires yearly adjustments to physician pay to bring it into line with an approved formula for sustainability; however, in practice it has resulted in large potential cuts that Congress overrides each year. Physicians and Medicare advocates have long urged a permanent fix for the SGR, but Congress to date has not been able to agree on how to offset the expense.
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Open Enrollment Begins Oct. 1. Are you ready?
October 1, 2013 is the start of open enrollment in health insurance exchanges and the Medicaid expansion. It’s also when many of the consumers that your organization serves will become eligible for one of these new coverage options.
Are you ready? Are they ready?
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