The pulse of healthcare: Baker Tilly healthcare update March 17, 2015

At the agencies

On March 4, 100 doctors’ groups led by the American Medical Association, sent a letter to the Centers for Medicare & Medicaid Services (CMS) requesting that the agency develop a plan for dealing with an expected large increase in rejected claims after the ICD-10 coding system takes effect in October of this year.  In a recent test of the ICD-10 system, CMS showed that the rejection rate for claims would increase from 3 to 19 percent if the coding system were implemented today.  Although the Government Accountability Office had recently stated that CMS does have a plan for dealing with this influx of rejected claims, this plan has not been made available to the public. 

On March 2, CMS provided a review and report of its quality reporting programs.  The review, which covers the 2006 to 2012 timeframe, illustrates a 95 percent improvement in the quality measures used in seven different CMS programs.  In linking quality reporting to improvement for treatments, the review showed that improved quality of care saved 7,000 to 10,000 lives for those being treated for heart failure and prevented between 4,000 to 7,000 infections due to surgical procedures.  According to CMS, the review and report can be used by providers to determine the quality measures that are working best and CMS expects that providers will modify their procedures to achieve a higher quality of care in their own practices.

On February 27, CMS announced that 7,000 physicians will receive higher Medicare payments in 2015 under the Value-Based Payment Modifier program, which was created under the Affordable Care Act (ACA).  According to the announcement, these physicians come from 14 group practices and their receipt of increased Medicare payments is based on their 2013 performance.

On February 25, CMS announced that the deadline for physicians to attest to the meaningful use program for electronic health records (EHR) will be extended from February 28, 2015 to March 20, 2015.  CMS had already extended the attestation deadline to hospitals from November 30 to December 31 in 2014. 

On the Hill

On February 26, the House Ways and Means Committee passed four pieces of healthcare related bills out of the committee.  Among the bills passed were the “Electronic Health Fairness Act” (EHFA) and the “Protecting the Integrity of Medicare Act of 2015.”  Under the EHFA, ambulatory surgical centers would be exempt from the EHR meaningful use program until the Office of the National Coordinator for Health Information Technology creates standards for such facilities, which currently do not exist.  The “Protecting the Integrity of Medicare Act of 2015” targets the prevention of identity theft by requiring that Medicare cards no longer include Social Security numbers, directs the Department of Health and Human Services to explore “smartcard” technology options for Medicare cards, and allows beneficiaries to receive electronic notices regarding care.  The bill would also assist with fixing common billing mistakes and modify requirements for processing claims.  There has been no official date set for a vote on the bills in the full House.

In the courts

On March 4, the Supreme Court heard oral arguments from both sides of the King v. Burwell case that challenges the current structure of how individuals enrolled in ACA plans receive subsidies.  The plaintiffs in this case contend that the language of the law does not allow the distribution of subsidies by the federal government for ACA plans.  The defendants in this case, President Obama’s Administration, argue that the plain language reading does not take into account the intent of the law which would allow the current subsidy payment structure for ACA plans to remain in place.  The Supreme Court is expected to decide on the case in June.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.