Regulated transactions with physicians are now common for hospitals. With the significant number of physician practice acquisitions and other affiliations, the number of regulated transactions with physicians has gone up exponentially
In the fiscal year 2013 Medicare inpatient prospective payment system (IPPS) final rule, the Centers for Medicare & Medicaid Services finalized which hospitals are subject to the Hospital Readmissions Reduction Program (HRRP), as well as what portion of the IPPS payment will be affected by the readmission adjustment factor. The impact on the diagnosis-related group (DRG) reimbursement will begin October 1, 2012, with the beginning of the federal fiscal year (FY). Studies show nearly one in five patients discharged are readmitted within 30 days, at a cost to the Medicare program of $15 billion per year. Beginning in October, hospitals with readmission rates higher than a certain threshold for the three conditions below will be penalized up to 1 percent of their aggregate base DRG rate. The penalty increases to a maximum of 2 percent in FY 2014 and 3 percent in FY 2015. In addition, the list of conditions measured increases in FY 2015
As last reported, the long-term care (LTC) merger & acquisition (M&A) market had a record year in 2011 in terms of transaction volume, reporting approximately 74 percent more transactions than the annual average for the previous three years. Although 2011 was a tough year to follow for LTC M&A, the first quarter of 2012 started strong, matching the same period in 2011 with 39 reported transactions.
U.S. health care organizations have recently—or are currently—assessing their information technology operations and software systems for the effects of compliance with electronic health record (EHR) requirements and the pending implementation of ICD-10.
The Supreme Court upheld President Obama’s health care overhaul, holding that it is constitutional in substantially all respects. The ruling further confirms that major changes are coming as a result of the Patient Protection and Affordable Care Act and the Health Care and Education Tax Credits Reconciliation Act of 2010 . The acts have tax and penalty implications for both individuals and businesses.
On June 22, 2012, the IRS issued proposed regulations regarding several additional requirements enacted by the Patient Protection & Affordable Care Act applicable to tax-exempt hospitals.
The U.S. Supreme Court recently decided to uphold virtually all of the Affordable Care Act (ACA) as it was enacted. First and foremost, all Medicare-related provisions are left intact, so all payment cuts to providers that have already been implemented will remain
On Monday, May 21, 2012, the Centers for Medicare & Medicaid (CMS) published a reminder that, effective for services provided on or after July 1, 2012, the statutory moratorium allowing certain pathologists and independent laboratories to bill for the technical component (TC) of pathology services expires. This means the TC for those surgical pathology services provided under arrangement to Medicare hospital patients only will be considered covered and payable by Medicare if billed by the hospital. The hospital will receive additional payment under the Outpatient Prospective Payment System (OPPS) for services provided to outpatients, but such services are considered included in the diagnosis-related group reimbursement for inpatients
Payment Rate Updates CMS has proposed a 2.1 percent update to the federal operating standardized amount. This is based on a 3 percent market basket update, reduced by two factors mandated by the Patient Protection and Affordable Care Act (PPACA): a 0.8 percent economy wide productivity adjustment and an additional 0.1 percent reduction.
The Centers for Medicare & Medicaid Services (CMS) is accepting comments through June 25, 2012, on the proposed rule changes to the hospital inpatient prospective payment system (IPPS) for federal fiscal year (FY) 2013. The proposed rule identifies CMS’ changes to the annual payment policy updates for hospitals as well as revisions to the wage index, quality reporting requirements and value-based purchasing. The proposed Payment Rate Updates establish the FY 2013 operating standardized amount at $5,325.62, a 2.1 percent increase from prior year for those reporting quality data.