Health Insurance Exchanges Impact Patient Enrollment
The first installment of this four-part Health Capital Topics series will describe the operational challenges that federal and state government agencies faced during the 2014 Health Insurance Marketplace Enrollment period. The 2014 enrollment period concluded March 31, 2014, with over 8 million U.S. citizens purchasing health insurance through an online interface. During the 2014 enrollment period, the online interface, commonly referred to as the Marketplace, was managed by state and federal government agencies, which faced numerous technical difficulties and glitches. These challenges may be recognized and resolved when improving the Marketplace prior to the 2015 enrollment period, which begins November 2014. (Read more...)

CMS Issues Final Prospective Payment System for FQHCs
The Center for Medicare & Medicaid Services (CMS) issued the final rule on prospective payment systems for Federally Qualified Health Centers (FQHC) on April 29, 2014. The final rule, serving as the product of a ACA directive to reform previous payment methodologies to FQHCs, creates an encounter-based per diem rate that increases the overall bundled payment made to an FQHC per patient visit. This final rule increases current reimbursement rates by 13%; sets the base rate higher then proposed in 2013 at $158.85; and, establishes a formula for coinsurance. The implementation of the new prospective payment systems is effective October 1, 2014 (Read more...)

Telemedicine Guidelines Adopted by State Medical Boards
In April 2014, the State Medical Boards' Appropriate Regulation of Telemedicine (SMART) Workgroup passed The Federation of State Medical Boards Model Policy, which is a new model for telemedicine policy. The Model Policy addresses each aspect of telemedicine, including appropriate online medical care; physician-patient relationship; HIPAA compliance; patient privacy; informed consent; and, drugs prescriptions. The Model Policy also ensures that patients are protected in an era where advancement of medical and communications technology is becoming more prevalent and attractive in the healthcare industry. This redefinition by FSMB has generated a heated debate from advocates like American Telemedicine Association, which asserts that the policy could impede the innovative progression in the field because the policy "does not appear to reflect current regular uses of telemedicine and raises significant barriers to its use." (Read more...)

Jimmo Case Re-Review Deadline Approaching
Until July 23, 2014, CMS will accept applications for re-review of skilled nursing facility (SNF); home health (HH); outpatient therapy (OPT); and, inpatient rehabilitation facility (IRT) service claims denied by CMS between January 18, 2011, and January 24, 2013, because of a Medicare beneficiary's "failure to improve or to have the potential to improve." The re-review deadline limits the window in which beneficiaries and providers can recoup monies lost due to the allegedly improper use of the "improvement" rule of thumb by Medicare claims contractors to deny coverage for skilled care services when a beneficiary has little to no potential for improvement of health status. (Read more...)