Literature Review

Medicaid disenrollments higher than expected: Report Becker's Payer Issues; by Rylee Wilson; 5/2/24 The number of people disenrolled from Medicaid through the redeterminations process has surpassed original estimates from the Urban Institute and Robert Wood Johnson Foundation. According to a May 2 report, as of November 2023, nearly 9 million people had been disenrolled from Medicaid. The figure came out to 60.5% of the foundation's original estimate of 14.8 million people losing coverage, with several months remaining in the redetermination process. 

Hospice remains a blind spot for Medicare Advantage Axios; by Maya Goldman; 5/6/24 As Medicare Advantage grows bigger and bigger, there's one area the industry and regulators haven't figured out how to make work yet: hospice. Why it matters: The end-of-life care option is the only Medicare service that can't be offered in the private-run alternative, which now covers over half of enrollees. ... Catch up quick: Usually, when a Medicare Advantage beneficiary decides to enter hospice after receiving a terminal diagnosis, traditional Medicare pays for this care while they remain enrolled in their private plan. ... Editor's Note: This practical, user-friendly article outlines the purposes, challenges, and outcomes of Medicare Advantage with hospice patients. Share this with your leaders and board members.

MultiPlan, insurance giants sued over out-of-network rates Modern Healthcare; by Nona Tepper; 4/29/24 A rural health system sued technology company MultiPlan and eight of the country's largest insurance companies over alleged schemes to strongarm providers into accepting low out-of-network rates. At issue in the proposed class-action suit are MultiPlan's repricing tools, which allegedly rely on insurers' data to deflate their out-of-network reimbursement payments. 

Minnesota’s new labor board votes for nearly $23.50 an hour minimum wage for nursing home workers Minnesota Reformer; by Max Nesterak; 4/29/24 'Today has been a long time coming,’ said nursing home worker Nessa Higgins at a news conference after Minnesota’s first labor standards board voted on April 29, 2024, to raise the minimum wage for nursing home workers to $20.50 per hour by 2027. Minnesota’s new workforce standards board took its first significant vote on Monday, agreeing to raise the pay floor to $23.49 per hour on average in 2027 for nursing home workers, while guaranteeing 11 paid holidays. The worker and government representatives on the board approved the minimum wages without the support of the board’s nursing home industry representatives, who abstained.

Hospice Claims Edits for Certifying PhysiciansCenters for Medicare & Medicaid Services (CMS); Related CR Release Date 4/18/24; Effective Date: 5/1/24; Implementation Date: 10/7/24Related CR Title: Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare EnrollmentStarting May 1, 2024, we’ll deny hospice claims if the certifying physician, including hospice physician and hospice attending physician, isn’t on our PECOS hospice ordering and referring files. This addresses hospice program integrity and quality of care per Section 6405 of the Affordable Care Act.

Congresswoman Kat Cammack introduces legislation to block 80-20 Rule Home Health Care News; by Joyce Famakinwa; 4/26/24 ... On Thursday, Congresswoman Kat Cammack (R-Fla.) introduced a bill to block the U.S. Department of Health and Human Services (HHS) from finalizing the 80-20 provision. Additionally, the legislation would also block HHS from implementing any similar rules that place a minimum requirement for how much of Medicaid spending on HCBS goes towards direct workers’ wages. Cammack’s reason for introducing this legislation is her belief that the 80-20 provision will severely limit access to care at a time when providers are already struggling to serve patients.

Getting your claims denied? Here are reasons why and what you can do about itMedial Economics; by Gretchen Heinen, RN, PHN, BSN and Wael Khouli, MD, MBA; 4/25/24A recent voluntary, national survey by Premier shed new light on denied claims. The survey, conducted from October to December 2023, revealed that nearly 15% of all claims across Medicare Advantage, Medicaid, Commercial, and Managed Medicaid are denied. Of those denied claims, 45% to 60% were overturned, albeit with a costly appeal process sometimes involving multiple appeals. ... With a skillfully crafted appeal letter, a denial can be overturned 50% to 70% of the time. In this article, we will cover denial basics, reasons for claim denials, and actions to take. It is crucial to address all potential reasons for claim denial, including: ...

Payment cuts are having a compounding, dire effect on the home health industry Home Health Care News; by Andrew Donlan; 4/25/24 Home health providers’ fight against cuts to fee-for-service Medicare payment has become a year-by-year battle. But the yearly cuts are compounding, which is exactly what industry advocates are trying to illustrate to Congress prior to the next payment rule proposal. ... Many of the cuts CMS has implemented are permanent, and multiple cuts on top of each other moving forward – plus unsatisfactory adjustments for inflation – are putting significant pressure on providers.

How the FTC noncompete ban affects nonprofit providers Modern Healthcare; by Alex Kacik; 4/25/24 The Federal Trade Commission’s ban on noncompete agreements will apply to some healthcare nonprofits, lawyers said. ... In the final rule, the FTC offers an example of a nonprofit hospital that employed 100 physicians. The commission would have jurisdiction “because the organization engaged in business on behalf of for-profit physician members,” the rule states. ... The FTC created a carve-out for senior executives in the final rule. Existing noncompete agreements with senior executives, defined as workers who earn more than $151,164 a year and are in policymaking positions, can remain in place. But employers are barred from enforcing new noncompete provisions with senior executives.

Commercial Capital Connect unveils $25M financing for home health care & hospice agencies nationwide – revolving credit lines & term loans up to $750K Consumer Infoline; 4/25/24Commercial Capital Connect, a leading marketplace for commercial finance solutions, today announced the launch of a $25 million financing program to provide revolving lines of credit and term loans to home health care and hospice agencies across the United States. ... “The home health care and hospice sectors play a vital role in our communities, providing essential services that enable people to receive quality care in the comfort of their homes,” said Cheryl Tibbs, President of Commercial Capital Connect. 

Medicare Advantage complaints that the plans don’t want – and the review of systems that wasn’t done RACmonitor, by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 4/24/24 ... In the past, I have talked about complaining to your regional Centers for Medicare & Medicaid Services (CMS) office about violations of CMS-4201-F, but Dr. [Eddie] Hu described how to do it to actually get action. [Click on the title's link for details] ... Now, why should you take the time to file these complaints? ... Why should you take the time to file these complaints? Because CMS tracks formal complaints, and a lot of complaints can significantly affect their quality bonus – and we know how when their money is at risk, the MA plans suddenly pay attention. ...

What the ‘fundamentally contradicting’ Medicaid Access Rule includes Home Health Care News, by Andrew Donlan; 4/22/24 The White House teased the finalized Medicaid Access Rule early Monday, and the Centers for Medicare & Medicaid Services (CMS) later revealed more intricate details attached to the rule. [The] timeline of the rule is now clear. Specifically: ... [Click on the title's link for more]

Save A Lot donates 7,000 pounds of food and $500 to local hospice Hazard Herald [KY], by Justin Begley; 4/18/24Save A Lot has once again lent its support by donating seven thousand pounds of food and water, along with a $500 gift card, to the Greg and Noreen Hospice Center. This year marks the fifth consecutive year that the grocery chain has made such a donation to hospice. Jason Smith, a district manager for Save A Lot, alongside management from other stores, was on hand to unload truckloads of supplies to replenish the hospice’s pantry ...