Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

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Reinstated Policies Could Backfire

Yesterday, we told you President Obama decided that insurance companies will not be required to upgrade their plans to fit the ACA’s requirements for 2014.  However, it looks like the change could lead to increased premiums; also, Washington and Arkansas, have indicated that they will not allow insurers to reinstate canceled plans.

Insurance companies will now be able to decide if they want to continue to offer the non-complying plans in 2014, but they will need their state’s permission.  In addition, insurers will have certain requirements including notifying customers of the benefits their plans exclude and informing their customers about other options available (such as the options available through the exchange).

Insurers warn that changing the rules may destabilize the market and lead to higher premiums.

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Update: Grace Period on “Two-Midnight” Rule Extended

CMS has extended the grace period on the two midnight rule (see here to read about the rule).  RACs will be able to “scrutinize claims” starting in April, giving hospitals a three month extension of the grace period.  After April 1, there will be RAC reviews for all submitted hospital claims that don’t break the two-midnight threshold.  Any claims that do break the threshold will be considered medically necessary and will not be reviewed.

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November is National Homecare and Hospice Month!

The purpose of this month is to raise public awareness of homecare and hospices. HMS would like to thank the millions of workers in the homecare and hospice industry who work tirelessly to help those in need!

Click here to read more from the NAHC

Study: 17 Million People Eligible for Subsidies

According to a new Kaiser Family Foundation study, 17 million people who are currently uninsured or buy their own health insurance will be eligible for tax credits to help purchase health coverage. More than a third of those eligible reside in either California, Texas or Florida. These three states also have the highest numbers of uninsured residents and the largest amount of people eligible for tax credits.

A different study from the McKinsey Center for U.S. Health System Reform found that six to seven million people may be eligible to use their federal subsidies to cover the entire premium of the lowest priced plan (the bronze plan).  Although bronze plans are the least expensive, they require the most out-of-pocket costs.

The Kaiser Family Foundation study estimates that approximately 29 million people may be able to buy coverage on the exchanges.  The amount of tax credit each person receives depends on certain factors such as their family income.

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Bundled Payments for Dummies: Models 2 & 3

As we continue our bundled payment series (see here and here), focused on a new payment model which combines fee for service reimbursement and capitation, we’d like to introduce you to the second and third bundled payment models.  The following explains each:

Retrospective Acute Care Hospital Stay plus Post-Acute Care:  This model is initiated by a patient admission, either to a participating acute care hospital, or by a participating physician group.  The bundle includes all costs associated with hospitalization as well as all post acute and other related services during that episode of care which can end after 30, 60, or 90 days after a hospital admission.  Participants will be able to choose from 48 different clinical condition bundles.  All providers are paid as usual by CMS but then costs are reconciled with predicted bundle costs retrospectively every quarter.

Retrospective Post-Acute Care Only:  This episode of care will be generated by an acute care hospital stay and will start at initiation of post-acute care services with participating skilled nursing facilities, inpatient rehab facilities, and long-term care hospitals, or home health agencies.  The services in this episode must begin within 30 days of discharge from inpatient stay and would end 30, 60, or 90 days after initiation of the episode.  Participants in this model will be able to choose from 48 different clinical condition bundles.

Stay tuned to learn about the final model and if you need more information on bundled payments, please call us at (203) 294-6659.

HIPAA Violations Can Lead to Prison Time

A Florida nursing assistant in an assisted living center has been sentenced to three years in prison for stealing and selling patient information.  The assistant worked at a 20 bed facility in Clearwater, Florida; this past summer, she pleaded guilty to conspiring to defraud the government and disclosing HIPAA information.  According to reports, she and another man worked together on the scheme until they were caught by undercover police officers who purchased the information.  Interestingly enough, the woman made very little money through the plan and will now spend 37 months in prison.

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