KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Alliance Of Medicare Providers Urge Link Between Payment Changes, Quality

The Premier healthcare alliance is urging that, if scheduled 2 percent cuts take effect, they not apply to hospitals that have already reduced costs.

Modern Healthcare: Providers Want Medicare Payment Changes Tied To Quality
Health Care providers are pushing for Medicare payment changes based on quality during the recently started post-election lame duck session of Congress. Premier healthcare alliance is urging Congress to ensure that if a scheduled 2 percent cut to Medicare providers does go into effect next year, it will not apply to hospitals that have enacted demonstrable cost reductions. Blair Childs, Premier's senior vice president for government affairs, said in an interview that the alliance of more than 2,700 hospitals is urging a requirement that the CMS calculate the extent to which hospitals have reduced their Medicare costs recently when applying the deficit-related across-the-board cut (Daly, 11/13).

Meanwhile, coverage continues regarding improper therapy claims submitted by skilled nursing facilities --

Los Angeles Times: Medicare Paid $1.5 Billion In Improper Therapy Claims In 2009
Medicare paid $1.5 billion in improper claims for skilled nursing care in 2009, federal investigators found. The inspector general of the Department of Health and Human Services said Tuesday that 25 percent of all Medicare claims submitted by skilled nursing facilities had errors and the majority of those bills were "upcoded" for ultra-high therapy that wasn't necessary (Terhune, 11/13).

In other news related to health care billing and payment --

Modern Healthcare: AMA Continues Fight Against ICD-10 Mandate
The American Medical Association reaffirmed its commitment "to vigorously work" against the nationwide adoption of ICD-10 diagnostic and procedural codes while evaluating the feasibility of skipping directly to ICD-11 codes, which are expected to be introduced in 2015. The AMA House of Delegates adopted a resolution at its annual meeting in Chicago this summer to weigh skipping ICD-10 and debated the issue again Monday during its interim meeting in Honolulu after two related resolutions were put on the meeting's agenda. A resolution introduced by the Florida delegation cited an $80,000-per-physician implementation cost for ICD-10 and noted that -- for all its complexity -- ICD-10 does not include codes for genomic information (Robeznieks, 11/13).

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