HFMA NEWS: “Obama’s Deficit Reduction Proposal Would Cut Medicare, Medicaid Spending” (April 15, 2011)

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Obama’s Deficit Reduction Proposal Would Cut Medicare, Medicaid Spending

President Obama on Wednesday outlined a proposal to cut the federal deficit by $4 trillion over 12 years, in part through significant reductions in Medicare and Medicaid spending over that period.

Specifically, the proposal calls for Medicare and Medicaid reductions of $340 billion by 2021, $480 billion by 2023, and at least an additional $1 trillion over the following decade, according to a White House fact sheet. Obama’s plan would also strengthen the Independent Payment Advisory Board (IPAB) created by the Affordable Care Act by setting a more ambitious target of holding Medicare cost growth per beneficiary to GDP per capita plus 0.5 percent beginning in 2018. The IPAB would also promote value-based benefit designs and would be given additional enforcement mechanisms.

To achieve $100 billion in Medicaid savings over 10 years, Obama’s framework would replace the current federal matching formulas with a single matching rate that rewards states for efficiency and automatically increases if a recession results in increased Medicaid enrollment. Obama has also asked the National Governors Association to recommend strategies for reforming Medicaid, and his plan supports incentives to deliver more efficient and higher quality care to high-cost beneficiaries.

Limiting “excessive” payments for prescription drugs would save $200 billion over 10 years under Obama’s proposal. The framework advocates leveraging Medicare’s purchasing power, speeding up the availability of generic biologics, prohibiting brand-name companies from entering into “pay for delay” agreements with generic companies, and managing Medicaid’s high prescribers and users of prescription drugs.

The president’s proposal also seeks to reduce Medicaid and Medicare abuse by stopping states’ use of provider taxes to lower their own spending without providing additional Medicaid services, recovering erroneous payments from Medicare Advantage, and establishing upper limits on Medicaid payments for durable medical equipment.

Posted on 4/14/2011 6:00:41 PM

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5 Way Consumer-Driven Healthcare changes everything in IT

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Developing a Revenue Integrity Improvement Plan

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According to the recent “Developing a Revenue Integrity Improvement Plan” article posted by the Healthcare Financial Management Association, the five key areas should be addressed when assessing how to increase cash flow:

  • Accuracy of patient information
  • Verification of payer information and policies
  • Accuracy of documentation
  • Processing of claims
  • Accuracy of payment

“Achieving revenue integrity means ensuring that providers are paid fairly, accurately, and quickly by all payers for care and services rendered to patients. It also involves eliminating the potential for lost revenue opportunities at every point in the revenue cycle.”

To read more on this article, please visit Kate Banks article by clicking here

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Payment Strategies for a Post-Healthcare Reform Era

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RAC Audit: The Four Steps You Should Take

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Healthcare Financial Management Association’s recent “Positioning Your Organization for a RAC Audit” article, outlines four simple and highly necessary steps you should take to help prepare for a RAC audit:

  • Undertake a self-assessment.
  • Resolve potential overpayments and false claims implications.
  • Set a reserve.
  • Prepare for a timely response to record requests.

For more on the “Positioning Your Organization for a RAC Audit” article, please click here

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“The prudent see danger and take action; the simple keep going and suffer for it.”

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In his “Trends Versus Fads, Action Versus Reaction” article, Larry Scanlan looks back at the 1990s and the movement that took place in the healthcare industry. As we begin a new year, Scanlan observes the healthcare industry’s outlook ” to prove and document the quality of care and provide it at a competitive cost while complying with increasing rules, regulation, and laws, and tightened reimbursement.” However, he asks is this outlook a trend of simply a fad?

To read more on the “Trends Versus Fads, Action Versus Reaction” article, please click here

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Affordable Care Act: An Overview

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A recent video posting on Siemens provides a valuable overview of the Affordable Care Act, a driver of value-based purchasing and new delivery models. To listen to this video, please click here

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Center Stage: Single Payer System

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New governor-elect Peter Shumlin advocates usage of single payer systems “first and foremost as an economic issue based on the trajectory of  cost increases for the state, employers and individuals.”

While this is not a current requirement, the article, “Single Payer System Takes Center Stage in Vermont,” suggests that the implementation of a single payer system, would “reimburse based on outcomes rather than fee for service using technology for medical records and payment.”

The article quotes Shumlin, “in Vermont, the cost of health care is estimated to increase by $1 billion from 2010 to 2012.” With such numbers, consideration of a single payer system is definitely worth considering.

To read more on this article, please click here

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MAP KEYS – Indicators of Revenue Cycle Excellence

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HFMA’s MAP KEYS are a set of standards for revenue cycle excellence. It defines the indicators, offers resources to track and improve performance, and honors excellence.

For more information on the MAP KEYS, please click here

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9 Strategies for Maintaining Profitability in 2011 and Beyond

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It’s no surprise that  in Becker’s Hospital Review “9 Strategies for Maintaining Profitability in 2011 and Beyond” article, number 8 addresses the importance of “adopting healthcare IT solutions that can help increase profitability.”

The article defines this strategy as “two-pronged” as providers will be able to cash in on incentives for this usage. Additionally, it  adds such benefits as tools used to minimize costs and increase efficiency.

To read about hospitals that have successfully utilized IT solutions, please click here

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