Many Nonprofit Hospitals Sue Poorest Patients

Recently, NPR and ProPublica have been reporting about nonprofit hospitals that seize the wages of lower-income and working-class patients. Each year, hundreds of patients get their paychecks docked by hospitals and their debt collection arms. One family interviewed by NPR should have qualified for free medical care under the hospital’s own charity care policy. Instead, the family has been getting their wages seized for nearly 10 years, and still owes $25,000. Senator Chuck Grassley, the chairman of the Senate Judiciary Committee, says hospitals could be breaking the law by suing patients and docking their pay.

Grassley, R-Iowa, says he is “astounded” by these collection practices. Grassley has been working to make nonprofit hospitals more accountable for the huge tax breaks they get. Nonprofit hospitals don’t pay federal income tax or local property tax and in order to justify their tax-exempt status, must “earn” it by “taking care of people who couldn’t provide for their own health care.” Grassley says that under the ACA, a hospital has responsibility to make a determination: Can the person pay, or can they not? The ACA requires that hospitals take the initiative to determine whether patients qualify for aid and should not shift that burden onto patients. Grassley is now focusing on sending a wider message to nonprofit hospitals that he believes are being too aggressive collecting bills from patients who can’t afford to pay. According to Grassley, if hospitals don’t get the message, the health law may need to be strengthened so the poorest patient receive financial assistance.

Click here to read more.

Clarification Of CMS’ Final Rule Language Addressing 30 Day Therapy Reassessment Change

CMS has clarified the final rule language that appeared in the Federal Register on November 6, 2014, entitled “Medicare and Medicaid Programs; CY 2015 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Survey and Enforcement Requirements for Home Health Agencies.” The 30 day reassessment applies to episodes that begin on or after January 1, 2015. There was an inconsistency error in the final rule where it stated “ending on..” in one place and “beginning on…” in another. CMS has clarified that it meant to state the therapy reassessment changes finalized in the regulations are effective for episodes beginning on or after January 1, 2015. Every 30 days, a qualified therapist must provide the needed therapy service and functional reassessment of the patient. If more than one discipline of therapy is provided, a qualified therapist from each of the disciplines must provide the needed therapy service and functionally reassess the patient at least every 30 days.

Click here for more information.

EHR Incentive Program Blog Series Part VII: Attestation

In our last EHR Incentive Program blog series post, we’ll look at the final step: attestation.

Attestation is a legal statement that you have met all the thresholds and requirements of the Medicare and Medicaid EHR Incentive Programs. The process of attestation happens through an internet-based CMS system that allows you to enter certain required information, including 15 core objectives, 5 out of 10 menu objectives, 3 core (or 3 alternate core) clinical quality measures, and 3 out of 38 additional quality measures.

So, where do you go to attest? For the Medicare EHR Incentive Program, you will attest through the same system where you initially registered. Click here to go to the CMS EHR Registration and Attestation system. During the attestation process, you will enter data and answer questions on the core objectives, menu objectives, and clinical quality measures.  There is an attestation guide to help you through the process. Click here to download it.

After you attest, you will find out immediately if you have successfully achieved the core and menu objectives of the program. If you are not successful, you can edit any information that was incorrectly entered and resubmit your attestation. You may also resubmit for a different 90 day reporting period with new information. If you are successful, CMS will perform internal checks to make sure you are eligible for payment. You will receive your EHR incentive payment approximately 4-8 weeks following attestation.

The attestation process for the Medicaid EHR Incentive Program is similar. First year participants are required to demonstrate the ability to adopt, implement, or upgrade certified EHR systems. This can be done by submitting the CMS EHR Certification Number obtained from the Certified Health IT Product List (CHPL) for your certified EHR through your state Medicaid agency site. Second year participants are also required to attest through you state internet-based portal, but you will only attest to meeting meaningful use requirements (as well as having met all other eligibility criteria).  For more information on your state’s internet-based portal, click here. States are required to issue Medicaid incentives payments within 45 days of completing all eligibility verification checks.

This post concludes our EHR Incentive Program Blog Series! Click here to see EHR Incentive Program FAQs from CMS.

EHR Incentive Program Blog Series Part VI: Registration

Now that you know some of the basics about the EHR Incentive Program, let’s take a look at the registration process.

If you fall into one of the eligible professional categories and have decided to participate in the Medicare EHR Incentive Program, the next step will be registering for the program. You can register here.  Please note, registering does not mean that you have to participate. By registering, you can see if you are hospital-based or if there are other issues that could interfere with or delay your participation. Click here to download a Registration User Guide.

If you fall into one of the qualifying eligible professional categories and have checked to make sure your state is currently participating in the Medicaid program, the next step is getting registered. Click here to register with CMS online. As with the Medicare EHR Incentive Program, registering does not mean you have to participate. You may cancel your registration at any time.

After registration, CMS will send your information to your individual state. 24 hours after successfully registering, you will need to log into your state program’s website to verify your registration and provide additional eligibility information. Click here to download a Registration User Guide that will give you step-by-step directions on how to register online.

Stay tuned to the HMS blog tomorrow as we conclude our EHR Incentive Program blog series!


DSS Announces Increase In Home Health Medicaid Rates Starting January 1, 2015

We have been notified by the Connecticut Association for Healthcare at Home that Medicaid home health rates will be increased by 1% across the board. DSS has released a Provider Bulletin describing how the Department is increasing fees paid to home health agencies by 1% effective for dates of service January 1, 2015 and forward.

An updated fee will be posted on the Connecticut Medical Assistance Program website with an effective date of January 1, 2015.

Click here to see the Bulletin.

EHR Incentive Program Blog Series Part V: Eligibility

Before you take any steps, make sure you are eligible for the program. For the Medicare EHR Incentive Program, only “eligible professionals” can participate. Eligible professionals include doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatry, doctors of optometry, and chiropractors. Please note, because incentive payments are made to individual providers, practices are not eligible to participate. However, a provider can designate a practice to receive the incentive funds on their behalf. It is up to the provider to make this decision and the practice or medical group cannot claim the money or make the decision for the provider, even if the EHR belongs to the practice. Additionally, hospital-based providers cannot participate .

For the Medicaid EHR Incentive Program, eligible professionals include physicians, nurse practitioners, certified nurse-midwives, dentists, physician assistants (who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is lead by a physician assistant). Certain states allow for optometrists to be eligible. For an optometrist to be eligible, the state Medicaid program must cover adult optometrist services as physician services in the Medicaid State Plan. Check with your state Medicaid agency for more information.

Further, an eligible professional must also meet certain criteria:

  • Have a minimum 30% Medicaid patient volume
  • Have a minimum 20% Medicaid patient volume, and be pediatrician
  • Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and have a minimum 30% patient volume attributable to needy individuals

Click here for more information from CMS regarding eligibility.

HHS Awards $665 Million To States To Improve Healthcare Quality, Accessibility & Affordability

The Department of Health and Human Services (HHS) recently announced the second round of grants as part of its State Innovation Models Initiative. The grants, totaling more than $665 million, will be split among 28 states, three territories, and the District of Columbia. The money will be used to “design or test innovative healthcare payment and service delivery models,” according to HHS and will reduce costs for Medicare, Medicaid, and the Children’s Health Insurance Program.

Click here to see the announcement.

Click here to read more.

EHR Incentive Program Blog Series Part IV: Penalties

Medicare eligible professionals who do not meet the requirements for meaningful use by 2015 and in each subsequent year will be subject to payment adjustments to their Medicare reimbursements that start at 1% per year, up to a maximum 5%.

For the Medicaid EHR Incentive Program, there are no penalties. Medicaid eligible professionals who are not eligible to participate in the Medicare and the Medicaid EHR Incentive Program will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.


Attention Hospices: CMS Releases Proposed Rule

CMS has issues a proposed rule (CMS-3302-P) to revise Conditions of Participation (CoPs) for providers, Conditions for Coverage (CfCs) for suppliers, and requirements for long term care facilities. The proposed rule is to ensure that certain requirements are consistent with the Supreme Court decision in United States v. Windsor, 570 U.S. 12, 133 S. Ct. 2675 (2013), and U.S. Health and Human Services policy. This Supreme Court decision is related to the Defense of Marriage Act.

The new rule addresses certain regulations governing Medicare and Medicaid participating providers and suppliers “where current regulations look to state law in a matter that implicates – or may implicate – a marital relationship.” CMS hopes to “provide equal treatment to spouses, regardless of sex, whenever the marriage was valid in the jurisdiction in which it was entered into, without regard to whether the marriage is also recognized in the state of residence or the jurisdiction in which the health care provider or supplier is located, and where the Medicare program explicitly or impliedly provides for specific treatment of spouses.”

CMS is accepting comments on the proposal until February 10, 2015.

Click here to see the proposed rule.

Click here to see the Fact Sheet.

Click here to read more from NAHC.

EHR Incentive Program Blog Series Part III: How Much Will You Get Paid?

The amount of your incentive payment depends on when you begin participating in the program. For the Medicare EHR Incentive Program, the incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap. The total maximum incentive amount that you can paid is $44,000 over five consecutive years of program participation. For providers who did not start by 2014, you are no longer eligible to receive an incentive payment under the Medicare EHR Incentive Program. Providers who started in 2011 or 2012 can receive the maximum payment.

For the Medicaid EHR Incentive Program, your incentive payment is a fixed amount each year and will remain the same as long as you meet all eligibility requirements for program participation. These requirements include adopting, implementing, upgrading to, or demonstrating meaningful use of certified EHR technology in your first year of participation, and achieving the meaningful use requirements for the remaining years you participate. The total maximum incentive amount that you can be paid under the Medicaid EHR Incentive Program is $63,750 over six years of participation, but participation does not have to take place across consecutive years. As long as you begin participating in 2016, you can receive the maximum Medicaid incentive payment.

Click here for more information regarding payments for the Medicare EHR Incentive Program and the Medicaid EHR Incentive Program.