Policy and Legislation
A lawsuit filed July 3 by roughly 50 doctors and a number of California medical groups including the Los Angeles County Medical Association and the California Medical Association accuses health insurer Aetna of regularly and systematically threatening doctors within its network with having their contracts with Aetna terminated for making out-of-network referrals.
Fifteen years after the Omnibus Budget Reconciliation Act (OBRA) directed the Centers for Medicare & Medicaid Services (CMS) to implement intermediate sanctions for noncompliant home health agencies (HHAs), the federal agency has finally complied.
When politics gets in the way of policy, you end up with the situations like what is happening now in Texas and Louisiana, where Governors Rick Perry and Bobby Jindal, respectively, both strident and vocal Republican opponents of "ObamaCare," are on the record as saying they will not expand Medicaid in their states. This despite the fact the expansion will be funded at 100 percent by the federal government through 2016 and at no less than 90 percent in ensuing years.
If you were to measure the influence any group has in politics by how much money is contributed to campaigns, the healthcare sector would deservedly be labeled influential. But lobbying insiders say it's not just the money that gives the healthcare industry authority - it's the effectiveness of the advocates the industry employs - and that effectiveness - maybe to the surprise of some - is dependent as much on trustworthiness as on anything.
The U.S. Department of Health and Human Services (HHS) on Aug. 7 released an interim final rule for making healthcare claim payments electronically and describing adjustments to claim payments. The department expects this next step in the adoption of operating rules to save up to $9 billion over the next 10 years.
Massachusetts Gov. Deval Patrick signed a bill Monday designed to control the state's healthcare costs. Included in the legislation is an overhaul of the medical liability system, which proponents say will decrease the cost of defensive medicine.
A trio of conservative health economists say that while the 2010 federal health law aims to slow health spending through programs such as value-based purchasing and bundled payments, it fails to fundamentally alter the healthcare financing system.
Home health agencies inappropriately paid $5 million for home health claims in 2010, found the Office of Inspector General in an examination of home health agencies' billing practices.
In fiscal year 2013, inpatient hospital payments will be increasing by 2.3 percent ($2.5 billion) under the final rule for the hospital inpatient and long-term care hospital prospective payment systems (PPS). The final rule was issued Wednesday night by the Centers for Medicare & Medicaid Services (CMS).