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House members urge HHS to address Medicare appeals backlog
AHA News Now
At a recent hearing on oversight of Medicare programs to recapture improper payments, members of the House Committee on Oversight and Government Reform pressed witnesses from the Centers for Medicare & Medicaid Services and Department of Health and Human Services to explain and address the growing backlog of appeals at the administrative law judge level. "I've talked to physicians, hospitals, health care providers and they say the first fair hearing they get is the administrative law side of it," said Rep. Mark Meadows, R-N.C.
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CMS releases finalized standards for 2015 marketplace
Earlier this week, the Centers for Medicare and Medicaid Services finalized the 2015 standards for all Affordable Care Act entities. Some of the provisions include:
  • A non-exhaustive list of state requirements that do not meet the federal standards and will therefore be pre-empted.
  • Circumstances when consumer assistance entities would be monetarily penalized for non-compliance.
  • An outline of the federally facilitated Small Business Health Options Program (SHOP).
  • Clarification on the quality rating system for marketplace plans.
For more information, click here.

To read the standards, click here.

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FY 2015 IPPS rule webinar scheduled for AHA members
On May 21 at 3:30 p.m. Eastern, policy staff from the American Hospital Association will present a 60-minute webinar to AHA members. AHA staff will discuss the proposed inpatient prospective payment system rule for fiscal year 2015. Topics to be covered are the disproportionate share hospital payments, the two-midnight rule, hospital wage index and hospital-acquired conditions program.

To register, click here.

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'Since You Asked' committee update
Q: How does the hospice benefit coordinate with a Medicare Advantage plan?

Hospice Benefit and Coordination with Medicare Advantage
When a Medicare Advantage enrollee elects to begin receiving hospice benefits any care and/or services related to their terminal diagnosis are paid by hospice. Hospice is paid a per diem by Medicare to cover the care related to the terminal illness. Care that is unrelated to the terminal illness and other traditional Medicare services will be covered by traditional Medicare. If the Medicare Advantage plan offers additional services not covered by Medicare then the Advantage plan will continue to provide those services.1

Revocation of the Hospice Benefit
When a patient revokes hospice, they are choosing to no longer receive their hospice benefit. At the time of revocation, care for all services resumes under traditional Medicare coverage unless the patient was enrolled in a Medicare Advantage plan at the time of hospice election. In that case, all claims will be paid by traditional Medicare until the first of the month following revocation. At that time, all coverage will revert back to the Medicare Advantage plan.2
To read the entire article, click here.

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Our unique blend of expertise and experience makes us the premier choice as your hospital case management partner offering solutions for contemporary case management redesign and education.
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Medicare may be overpaying hospitals for short-stay patients
Kaiser Health News
The federal government may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing a controversial rule that tells hospitals when patients should be admitted, an independent Medicare auditing company told a congressional panel. Last September, Medicare officials announced that patients whose doctors expect them to stay in the hospital through two midnights or longer should be admitted, while those expected to stay for less time should be kept for observation.
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House panel urged to provide relief on RACs, 2-midnight policy
AHA News Now
Hospitals need relief from the Centers for Medicare & Medicaid Services' two-midnight policy and Recovery Audit Contractor program — both of which are draining "time, resources and attention that need to be more effectively focused on patient-care," Amy Deutschendorf, senior director of utilization and clinical resource management at the Johns Hopkins Health System in Baltimore, told the House Ways and Means Health subcommittee. Testifying at a hearing on current hospital issues in the Medicare program, Deutschendorf said the two-midnight policy has created "confusion and stress" for providers and patients, and has "taken away physicians' judgment in the determination of hospitalization as an inpatient."
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House calls? One Alabama hospital starts anew with old practice
The Birmingham News
In an effort to ward off costly and unnecessary readmissions, Princeton Baptist Medical Center is starting a pilot program in which a small team of health care workers may come to recent patient's home to make sure everything is alright. Baptist Health System — a four-hospital group in Alabama — announced the nine-month pilot program. Each house call includes a medical resident, a nurse and a medical-education physician faculty member. The teams actually work before and after the hospital visit to ensure the patients are able to take care of themselves.
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Radiation beams fight tough colon cancer
Cleveland Clinic
Imagine focusing hundreds, or even thousands, of radiation beams on a cancerous tumor, hitting it hard with high-precision doses of radiation. It's called Stereotactic Body Radiation Therapy. While the technique is not new, it's now become available to treat colon cancers that have spread to a person's liver. Doctors have used SBRT in the U.S. over the last 15 years to treat lung, liver, prostate or spinal tumors. Expanding its use is an exciting development, in part, because it's a super-charged treatment.
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Date Event Location More Info
June 30 Northern California Chapter Conference Napa, Calif. Details
July 19 Georgia Chapter Conference Atlanta Details
July 31-Aug. 1 Florida Chapter Conference ChampionsGate, Fla. Details
Aug. 23 MO/IL Gateway Chapter Conference St. Louis Details
Sept. 6 Kentucky/Tennessee Chapter Conference Nashville, Tenn. Details
Sept. 11-12 South Carolina Chapter Conference Columbia, S.C. Details
Sept. 18 Missouri-Kansas Chapter Conference Kansas City, Mo. Details
Sept. 26 North Carolina Chapter Conference Winston-Salem, N.C. Details
Sept. 27 Maryland Chapter Conference Baltimore Details
Oct. 3 Great Lakes Chapter Conference Novi, Mich. Details
Oct. 11 Virginia Chapter Conference Richmond, Va. Details
Oct. 14 Wisconsin Chapter Conference Waukesha, Wis. Details
Oct. 25 Connecticut Chapter Conference Uncasville, Conn. Details
Oct. 28 Illinois Chapter Conference Rosemont, Ill. Details

  For the full ACMA event map, click here.



Laura Chambers, ACMA Communications Coordinator, 501.907.2262
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