Medicare Payment and Reimbursement

Sept. 12—A Medicare proposal to simplify evaluation and management (E/M) codes could hit hospitals’ bottom lines, hospital advocates recently warned the Trump administration.

HFMA submits comments to CMS on the CY 2019 Medicare Physician Fee Schedule Proposed Rule, published in the July 27, 2018, Federal Register.

Fee-for-service is still the dominant payment method because of certain economic factors and a traditional industrial mindset that values volume.

A deep understanding of active contracts, combined with proactive and purposeful performance monitoring and open communication with health plans must be in place to ensure that hospitals are appropriately paid and the incentives available to them are aligned.

Aug. 10—The U.S. Department of Health and Human Services (HHS) would receive a small increase and funding for several hospital priorities under a FY19 funding bill that the Senate is expected to vote on next week.

Aug. 6—More than 3,000 hospitals will receive an average increase of nearly 3 percent in their Medicare inpatient payment rates—along with a slew of policy changes—under a recently issued final rule.

Aug. 1—Post-acute care providers will see more than a $1 billion pay boost for FY19—along with a range of policy changes—as described in annual final rules issued by Medicare this week.

July 27—A range of major hospital policy changes includes a $760 million cut as part of the 2019 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.

The number of ACOs participating in the Medicare Shared Savings Program increased at a faster rate from 2013 to 2018 than did the number of participants that achieved shared savings in the first four years of the program.

An expansion of Medicare Advantage presents an opportunity for the U.S. to test the waters of a single-payer system.