Healthcare Regulatory Update - 2013

EisnerAmper's Healthcare Services Group presents its 2013 Healthcare Regulatory UpdateEisnerAmper's Healthcare Services Group presents its 2013 Healthcare Regulatory Update.   

As healthcare consultants in the northeast market (NY/NJ/PA) with a combined 20 years of experience, EisnerAmper's Healthcare Services Group consistently monitors and educates itself on all regulations and updates from the Centers for Medicare and Medicaid Services (CMS) as well as the latest in healthcare reform from Washington. This preparation allows the group to discuss, educate and provide an audience comprised of healthcare providers, office staff and outside healthcare professionals with the latest information on the issues impacting the healthcare industry.

The 2013 Healthcare Regulatory Update includes the latest information on: Healthcare Reform, an Ambulatory Services update that includes how to calculate whether Affordable Care Act (ACA) tax credit will pay off for your practice, and compliance concerns.


Marketplace Challenges

Health Care Reform

Ambulatory Services

Hospital Services

Compliance Issue


Ambulatory Services Overview

Beware of these 4 common myths when billing observation services

  • Primary care payment increase in proposed
  • Medicare Physician Fee Schedule (MPFS) tied to new G-code for post-discharge care
  • Imaging pay dips further as primary care services see increases in 2013
  • Participating in meaningful use could qualify you for new e-Rx exemptions


Marketplace Challenges

  • New Payment Methodologies
    • Accountable Care Organizations
  • Cost Increases
  • Consolidation
    • Merger
    • Acquisition
  • Overpayment Audits
  • Regulatory Changes


Health Reform

  • Medical Loss Ratio (MLR) Rebates for 2011 May Total About 10% Of Insurer Profits on Commercial Products
  • Observers Say Most States Won't Have Own Exchanges on January 1, 2014
  • Centers for Medicare and Medicaid (CMS) Final Fraud Rule Makes Only Minor Changes to Interim Rule
  • Health and Human Services (HHS) Finalizes MLR Rebate Notice Rule; Insurers Remain Dubious
  • Final Rule on Premium Tax Credit Leaves Family Coverage, Other Issues Unanswered
  • General Accounting Office (GAO) Says Small Employers Shun Too Complex Health Tax Credit
  • Premium Hikes Are Seen as Likely for Individual Health Coverage
  • HHS Rule Would Boost Medicaid Physician Pay Ahead of 2014 Influx
  • More Than a Dozen States Now Are Balking At Reform Statute's Medicaid Expansion
  • There Won't Be Any State-Specific Rate-Review Thresholds Sept. 1
  • Maine Gov. Says Supreme Court Decision Gives States Right to Cut Medicaid Rolls
  • New Debate Focuses on Impact of Essential Health Benefits (EHB) on Affordability of Coverage


Ambulatory Services

  • Prepare for self-pay patients to improve collections, avoid breached contracts
  • Outsource services - Balance benefits and risks by vetting Management Service Organization (MSO)
  • Template abuses: Allowing staff, not the physician, to complete History of the Present Illness (HPI)
  • Supreme Court upholds Affordable Care Act; expect more patients at your practice
  • How to calculate whether Affordable Care Act (ACA) tax credit will pay off for your practice
  • Ask surgeons to substantiate need for assistants to avoid denials
  • Make front desk changes to boost collections from patients with High Deductible Health Plans (HDHP)
  • Join an ACO that gives your physicians leeway, causes minimal restructuring
  • Learn from practices on Office of Inspector General's (OIG) Evaluation and Management (E/M) watch list for levels 4s, 5s
  • Take advantage of health plans' real-time insurance verification in 2013
  • Pre-payment Recovery Audit Contractor (RAC) audits may derail payment, require extra documentation
  • Secure meaningful use incentives by increasing patients' use of portals
  • CMS Finalizes Stage 2 Meaningful Use
  • HHS mandates National Provider Identifiers (NPI) for all providers, payer IDs alongside International Statistical Classification of Diseases (ICD) -10 delay


Hospital Services

  • Health Care Leaders Give Supreme Court Ruling Mixed Reviews
  • HHS: 12.8 Million Americans to Receive $1 Billion in Medical-Loss Ratio Rebates
  • HHS Awards $971 Million to Boost Disaster Planning
  • Study: Majority of Medicaid Emergency Department (ED) Visits Are for Urgent or More Serious Symptoms
  • As of July 1, an additional 89 new accountable care organizations began serving Medicare beneficiaries in 40 states and Washington D.C.
  • Poll: 61 Percent of Physician Leaders Agree with Supreme Court Decision
  • Study: Safety Net Hospitals Likely to Fare Poorly in Value-Based Purchasing Program
  • Survey: Medicare Beneficiaries Have Better Access to Care Than Adults With Private Coverage
  • Centers for Disease Control and Prevention (CDC) Survey: Most Office-Based Physicians Satisfied With Electronic Health Records (EHR)
  • Congressional Budget Office (CBO): Supreme Court Decision Reduces Cost of ACA by $84 Billion
  • Study: One in 10 Employers to Drop Health Coverage
  • Report: Spending on Children's Health Care Rising Faster than Spending for Adults
  • Survey: 60 Percent of Employers Expect Cost Increase from Affordable Care Act
  • Study: 31 Percent of Physicians Unwilling to Accept New Medicaid Patients
  • Survey: Hospital Leaders Reporting Increase in Operating Room (OR) Use
  • Study Finds 89 Million People Uninsured at Least One Month Between 2004 and 2007
  • CBO Reduces Medicare Spending Forecasts
  • Final Rules for Stage 2 Meaningful Use Released
  • Standard & Poor's (S&P) Issues Reports on Median Ratios and Cost Trends
  • Survey: Only 13 Percent of Hospitals Participating in or Planning ACOs
  • Government Accountability Office (GAO): Supplemental Medicaid Payments to Hospitals Rising
  • CMS Adds 17 Organizations to Care Transitions Program


Compliance Concerns

  • Stark Law Is Not Obstacle for Providers Shifting to Quality-Based Productivity Pay
  • OIG Starts Review of Billing Procedures on Short Hospital Stays for Cancelled Surgery
  • In New Angle on Stark Cases, Government Hits Hospitals for Lack of Physician Profit
  • Office of Civil Rights (OCR) Head Rodriguez Warns Lack of HIPAA Compliance "Unacceptable"
  • CMS May Change Definition of 'Inpatient' As Concerns Mount Over Errors, Copays
  • Real-Time Audits Help Providers Keep Pace With Filing Deadlines, Predictive Modeling
  • CMS Clarifies Diagnosis-related Group (DRG) Window Payment Rule as Extension Takes Effect
  • Coders Walk Fine Line of Clarifying Charts Without Questioning Clinical Judgment
  • Feds Turn Corner in Implantable Cardioverter- Defibrillator (ICD) Investigation; Hospital Liability Divided into Categories
  • Providers May Need to Reconsider Some Compliance-Program Tenets
  • CMS Announces Preapproval Process for Outpatient Rehab That Exceeds Therapy Cap
  • Hospices Are New Focus of Program for Evaluating Payment Patterns Electronic Report (PEPPER) Amid Growing Concern Over Potential Abuses
    • CMS Relents on More Outpatient Payment For Inpatient Denials in Wake of Administrative Law Judges (ALJ) Rulings
    • Partial Hospitalization Takes Hit From OIG, Is a New PEPPER Focus
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