CMS Releases Part B Inpatient Billing Proposed Rule and Administrator’s Ruling
On March 13, CMS released an administrative ruling and a proposed rule allowing Medicare to pay for additional hospital inpatient services under Medicare Part B. Specifically, the proposed rule would allow additional Part B payment when a Medicare Part A claim is denied because the beneficiary should have been treated as an outpatient rather than being admitted to the hospital as an inpatient. However, hospitals will only be able to rebill CMS within one year of when the services in question were furnished.
The CMS Ruling (CMS-1455-R) establishes a standard process for handling pending appeals and billing for the additional Part B inpatient services, while the proposed new policy goes through notice and comment rulemaking. The CMS ruling, effective March 13, will remain in effect until the proposed rule is finalized.
The policy changes will apply to all types of hospitals and critical access hospitals. The Federal Register will publish the Part B Inpatient Billing in Hospitals Proposed Rule and Administrator Ruling on March 18, 2013. The comment period for the notice of proposed rulemaking ends May 17, 2013.
MedPAC Publishes Annual Report
On March 15, the Medicare Payment Advisory Commission (“MedPAC”) released its annual report of payment recommendations to Congress. The report recommended a net increase in base payment rates from 2013 to 2014 of 1% for the hospital inpatient and outpatient payment systems. The report suggests cutting payments to skilled nursing facilities and home health agencies. The report reiterated a previous recommendation for Congress to repeal the sustainable growth rate system and replace it with legislated updates that would no longer be based on an expenditure-control formula.
MedPAC is an independent congressional agency established to advise the U.S. Congress on issues affecting the Medicare program. MedPAC issues reports every March and June, which are the primary outlets for Commission recommendations.
House, Senate Unveil Budget Plans
On March 12, House Budget Chairman Paul Ryan (R-WI) released the House Republican FY 2014 budget resolution, which aims to reduce the deficit by $4.6 trillion over the next 10 years. The 10-year fiscal blueprint lays out a plan to balance the budget within a decade by defunding the Affordable Care Act (“ACA”) and reducing Medicare and Medicaid.
The Ryan budget would repeal $1.8 trillion in new spending on the ACA as well as turn Medicaid into a block grant program. The budget would also give seniors the option of purchasing private insurance on an exchange and receiving “premium support” payments.
The budget proposal would means test beneficiaries. It also would put additional means testing on premiums for Medicare Part B outpatient services and Part D prescription drug benefits.
On March 12, Senate Budget Committee Chairwoman Patty Murray (D-WA) released the Senate FY 2014 budget, which would leave the ACA largely untouched but raise tax revenues by nearly $1 trillion, while cutting spending by the same amount over the next decade.
The release of the House and Senate budgets comes almost a month before the White House plans on releasing its FY 2014 budget.
House Energy and Commerce Committee to Hold Health IT Hearings
On March 12, the House Energy and Commerce Committee announced they will hold a “Health Information Technology” hearing series March 19-21 to discuss the role of technology in the health care industry.
On March 19, the committee will explore the impact of FDA regulation and taxes on mobile applications and devices. On March 20, the committee will discuss how technological advancements benefit patients, and on March 21, the committee will hear from HHS on the administration’s future plans for health information technology.
The hearings follow a House Republican letter to the FDA raising concerns that smartphones and mobile applications will be subject to taxes under the ACA if the FDA decides to define them as medical devices.
Bills Introduced This Week
H.R. 1201: Rep. Aaron Schock (R-IL) introduced a bill that would create 15,000 more medical residency positions under Medicare. The bill would mandate that 50% of the positions train residents in primary care. The bill would add 3,000 new graduate medical education (“GME”) positions at teaching hospitals every year for five years. The legislation would dole out slots based on need, with no hospital getting more than 75 additional slots per year. The increase in the number of GME positions would cost an estimated $9 billion to $10 billion over 10 years.
H.R. 1178: Rep. Kathy Castor (D-FL) introduced a bill that would amend the Public Health Service Act to authorize grants for GME partnerships in states with a low physician resident to general population ratio. The legislation was referred to the House Energy and Commerce committee.
H.R. 1179: Rep. Joe Courtney (D-CT) introduced a bill that would amend Title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare.
For more information, please contact John F. Williams, III at 317.977.1462 or jwilliams@hallrender.com.
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