A new Medicare hospice manual includes instructions for which principal diagnosis codes are acceptable and clarifies which codes should be used for services in a skilled versus non-skilled nursing facility, according to a CMS memorandum released last Friday. These changes go into effect October 1. The memorandum also states that a hospice claim should list a principal diagnosis “most contributory” to the patient’s terminal prognosis. Additionally, it clarifies several ICD-9 and ICD-10 codes that are not acceptable and the new time frames for submitting information to the Medicare Administrative Contractors.
Cross-training staff is an important part of efficiently running a practice. With limited staff, smaller practices are more likely to suffer without it. If an employee is ill, everyone else has to pitch in to keep the office running. When implementing an EHR system or other new software systems, make sure that all practice staff receive training on how to use all of the administrative functions of the system even if they do not use them on a regular basis. Administrative staff members should also be familiar with the clinical functions of the system. Clinical staff should be familiar with the administrative features. This will allow employees to better understand the workflows of the practice!
Earlier this week, the Congressional Budget Office (CBO) stated reduced costs for medical services and labor have reduced the 10-year projected cost of Medicare and Medicaid by $89 billion. Medicare spending is projected to decrease by $49 billion from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion. Despite the long-term projected drop, federal spending for major health programs will increase this year by $67 billion or approximately 9 percent. Medicaid is projected to grow by $40 billion, or 15 percent. The short-term increase is due to the ACA, including its Medicaid expansion and the financial assistance to help people purchase health insurance. CBO has also stated that it expects Medicare outlays to increase by about $12 billion this year.
Access Health CT, Connecticut’s online insurance exchange, has named James R. Wadleigh Jr. as interim CEO. Wadleigh is currently Access Health CT’s chief information officer; he begins his new role tomorrow. Earlier this week, Access Health’s current CEO Kevin Counihan announced he was resigning to lead the federal government’s insurance exchange, HealthCare.gov. Wadleigh has served as chief information officer since 2012 and has spent 25 years in information technology across multiple insurance industries, including healthcare, property casualty, life insurance and annuities.
A new report says a little-noticed provision in the federal health law could drastically reduce insurers’ ability to shield much of that pay from corporate taxes. Last year, insurers owed at least $72 million more to the U.S. treasury as a result. Researchers analyzed the compensation of 57 executives at the 10 largest publicly traded health plans and found that they earned a combined total of $300 million in 2013. Insurers were able to deduct 27 percent of that from their taxes as opposed to before the health law when 96 percent would have been deductible. The 2010 law states that insurers can deduct only the first $500,000 of annual compensation per employee from corporate taxes; the law also requires insurers to include “performance pay,” including stock options which often represent a large portion of an executive’s pay.The report found that on average, insurers owed $1.3 million more in taxes per executive and that the “performance pay” accounted for more than $204 million of the compensation awarded. In 2013 executive pay also rose an average of $5.4 million per person.
Kevin Counihan, CEO of Connecticut’s health insurance exchange, Access Health, is resigning to lead the once-troubled federal exchange, HealthCare.gov. Since 2012, Counihan has led Connecticut’s exchange which sells private insurance plans and enrolls people in Medicaid. The board overseeing the Connecticut exchange will appoint an interim CEO in the meantime and conduct a national search for Counihan’s replacement. Access Health has been one of the nation’s better-performing exchanges. In recent months, Access Health has been marketing its system to other exchanges as an alternative to building their own marketplaces from scratch. Currently, thirty-four states use the federal government to full or partially run their exchanges.