The following contains information on new initiatives, ongoing projects, and other related news about and from HFMA. Please bookmark this page as it will be updated periodically.
HFMA Key Hospital Financial Statistics and Ratio Median Trends
This presentation contains data trends for certain ratios featured in the HFMA Key Hospital Financial Statistics and Ratio Medians collected from 2005–2013. Ratio values are displayed for the company data with the highest trend line over the 9-year period.
View the presentation.
HFMA Comments on the Delay of RAC Appeals Assigned to Administrative Law Judges
HFMA voices concern and comments on the recent Office of Medicare Hearings and Appeals decision to suspend assignment of new RAC appeals cases to Administrative Law Judges.
Read our comment letter.
HFMA Comments on Medicare Disproportionate Share Hospital (DSH) Payment Reductions
With weeks remaining in the open enrollment period it appears highly unlikely that the CBO's May 2013 estimate of a reduction in the uninsured by 14 million individuals in 2014 will be achieved.
Read our comment letter.
Two-Midnight Clarifications, Tweaks Continue
Further details and tweaks to Medicare's new admissions policy continue to roll out months after full enforcement of the controversial policy change was delayed from October 2013.
Among the latest changes in enforcement of the so-called "two-midnight rule" is the order by the Centers for Medicare & Medicaid Services (CMS) that Medicare auditors re-review any "probe and educate" audits that led them to reject hospitals’ inpatient claims.
The probe-and-educate process, which allowed review of a limited number of claims, was instituted as the first step of a phased-in enforcement of the two-midnight admissions rule, which was issued by CMS on Aug. 2, 2013. Under the new admissions policy, a physician must certify that a patient’s condition required hospitalization for at least two midnights for the case to qualify for Medicare Part A payment. Full enforcement of the two-midnight rule was delayed until October 2014. The latest tweak requires Medicare administrative contractors (MACs) to re-review all claims denied since Oct. 1, 2013.
The re-reviews are intended to ensure that the decisions and subsequent education were consistent with clarifications of the two-midnight rule that CMS issued on Jan. 30.
Obama Proposes $3.5 Billion in Medicare Provider Cuts
Medicare would reduce payments to providers by nearly $3.5 billion under President Barack Obama's FY15 budget, released March 4.
The bulk of the provider cuts would come from $1.5 billion in cuts to post-acute providers and $960 million less for graduate medical education (GME), administration budget tables showed.
Even as the budget included $14.6 billion in 10-year GME cuts, the administration touted a new competitive graduate medical education program to provide $5.23 billion over 10 years to support 13,000 new residents. The proposed program included $100 million in mandatory FY15 funding to support pediatric training in children's hospitals.
The Medicare provider cuts, which total $354 billion over 10 years, include boosting the controversial Independent Payment Advisory Board to achieve nearly $13 billion more in savings.
The budget would derive nearly $1.7 billion in savings over the coming decade from reducing critical access hospital (CAH) payments from 101 percent of reasonable costs to 100 percent of reasonable costs. Another $720 million in CAH savings over 10 years will result from prohibiting CAH designations for facilities less than 10 miles from the nearest hospital.
HFMA Urges CMS to Adjust DSH Cuts
Amid expectations that enrollments in the government's new insurance marketplace will come in far below expectations, HFMA is urging a reassessment of DSH cuts that were based on earlier projections.
CMS calculated cuts in FY14 Medicare DSH payments, which were required by the ACA, based on projections that the number of uninsured would drop by 14 million in 2014.
In a March 10 letter to CMS, HFMA President and CEO Joseph J. Fifer, FHFMA, CPA, noted that the agency based its DSH reduction on the estimate of ACA-driven reductions in the uninsured rate made by the CBO in May 2013, instead of actual reductions in the uninsured resulting from the ACA.
"Given many states' refusal to expand Medicaid and develop health insurance exchanges or support enrollment efforts, our members believed the CBO's projected 2014 reduction in the number of uninsured individuals was overly optimistic," Fifer writes. "Our concern was that using the CBO's estimate would reduce Medicare DSH payments to hospitals beyond what was merited by the actual reduction in hospital uncompensated care resulting from fewer uninsured individuals."
Publication Date: Tuesday, April 01, 2014