Providers Discuss RAC Program with Senate Finance Committee
On Tuesday, June 25, the Senate Finance Committee held an oversight hearing on the Recovery Audit Contractors (“RAC”) program. With two of the three witnesses representing provider groups, the bulk of the hearing focused on the compliance burdens accompanying RAC document requests and reviews.
The Committee’s ranking member, Sen. Orrin Hatch (R-UT), said the high overturn rate of RAC decisions raises questions as to whether RACs are being “too aggressive or do not understand current medical practice.” Since its implementation, the RAC program has been subject to a fair amount of scrutiny in Congress, where bipartisan legislation has been introduced to curb the RAC process.
Tuesday’s hearing comes as Congress awaits an anticipated Government Accountability Office (“GAO”) report on the performance of RACs. Provider groups hope the report generates support moving legislation. As currently introduced, the Medicare Audit Improvement Act would limit the frequency of audits and establish penalties for auditors when their decisions are overturned on appeal. Despite Tuesday’s hearing and the pending GAO report, it remains to be seen whether the Senate will pursue substantive changes to the RAC program this year.
CMS Proposes Payment Changes for Medicare Home Health Agencies for 2014
On June 27, CMS announced proposed changes to the Medicare home health prospective payment system (“HH PPS”) for calendar year (“CY”) 2014. CMS projects that Medicare payments to home health agencies in CY 2014 will be reduced by 1.5%, or $290 million relative to CY 2013, based on the proposed policies.
The rule proposes a reduction to the national, standardized 60-day episode rate of 3.5% in each year CY 2014 through CY 2017. The proposed national, standardized 60-day episode payment for CY 2014 is $2,860.20. The proposed rates do not include the effect of the 2% payment reduction that began April 1, 2013 as a result of the sequester.
The final regulation is due out in late October, and insiders believe it could be slightly lower than the proposed rule. CMS will accept comments on the proposed rule until August 26, 2013.
Senate Committee Hears from Mark McClellan on Quality Improvement Measures
On June 26, former CMS Administrator Mark McClellan testified before the Senate Finance Committee in a hearing to examine the state of the national quality improvement movement. The former administrator stated that Medicare and other insurers should “sharply reduce the number of measures they use to assess the quality of care so that they focus on a few pivotal outcomes of treatment – not on how care is delivered.”
McClellan also called on Congress to make outcomes better aligned with physician payment reforms. Chairman Baucus (D-MT) described the hearing as a “gut check” on national efforts to improve quality and expressed interest in decreasing the number of measures. More than once he broached the possibility of including such changes in legislation addressing Medicare physician payments.
CMS Delays DME Face-to-Face Requirement
CMS will not enforce until October 1 the requirement that physicians or their assistants document face-to-face encounters with patients before patients receive certain home medical equipment. The face-to-face rule had been slated to go into effect on July 1. Earlier in June, CMS updated guidance regarding the rule, which included refusal to accept any claims where a face-to-face requirement was not met.
Bills Introduced This Week
S. 1198: Sen. Tom Coburn (R-OK) and Claire McCaskill (D-MO) introduced a bill to increase premiums that wealthier seniors pay for Medicare Part B (physician visits) and Medicare Part D (drug coverage). The legislation would increase premiums by 10% for those with incomes more than $85,000 annually.
S. 1228: Sen. Ron Wyden (D-OR) and Rob Portman (R-OH) introduced legislation to reward healthy lifestyles by paying seniors for achieving health care goals set by their physicians. The legislation aims to save Medicare billions by allowing seniors to receive up to $600 over three years for meeting goals in the areas of blood pressure, cholesterol, body mass index, diabetes, vaccinations and screenings. A companion bill, H.R. 2524, was introduced in the House by Rep. Erik Paulson (R-MN).
H.R. 2500: Rep. Devin Nunes (R-CA) introduced a bill that would amend Title XVIII of the Social Security Act to modernize payments for ambulatory surgical centers under the Medicare program. The bill was jointly referred to the House Energy and Commerce and Ways and Means Committee.
For more information, please contact John F. Williams, III at 317-977-1462 or jwilliams@hallrender.com.
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