DCMedical News: Thursday, February 28, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, February 28, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
Medicare for All: (see below, new bill unveiled).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Wearable Watches Will Create a “Tsunami” of Afib Claims:
So reports Medical Economics, here. The feature discusses best coding for maximizing reimbursement for services to those wearing watches with “digital health” capability that show signs of atrial fibrillation. The article notes the opportunity for primary care physicians to intervene with otherwise asymptomatic patients, prescribe and code using the “seven important Afib ICD-10-CM codes to know,” to “boost their quality scores and receive a financial bonus.”
Attention EPs: Today is the deadline for Medicaid Eligible Professionals (EPs) to submit 2018 attestation data for the Promoting Interoperability (a.k.a. meaningful use) Program. Oh, and starting January 1, 2020 only the new card (Medicare Beneficiary Identifier, the MBI) will be accepted for billing; on those cards there is no capital letter “O,” (only “0” as in 0-9 numbers), nor are capitals S, L, I, B or Z used.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Price Control Proposals Return to Vie with VBP, Antitrust Enforcement, Reference Pricing:
An essay in Modern Healthcare (here) notes that direct price control (as practiced in Maryland and Rhode Island with health insurance plans) is returning to policy discussions, given the failure of value-based payment, the apparent lack of appetite for antitrust enforcement (although some Republicans are rediscovering monopoly pricing, e.g. here) and the political difficulty of pursuing reference pricing. The Energy & Commerce Health Subcommittee will hold a hearing March 6, focused on prices and cost.
Independent Hospitals Survive as Independents Based on Pricing Tricks in Reimbursement:
A report (here) on the “disappearing” independent hospital contends that their continued independence is dependent either on Medicare reimbursement changes (for example, higher paid hospitals in “rural” areas suddenly categorized as being in lower-paid urban areas) or the higher prices available from consolidated systems (“must have” participants in health insurance networks).
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Nurses, Democrats and Supporters of “Medicare for All” Unveiled the New Bill in Washington:
Robert Pear chronicled opposition to the one or more of the proposals (Medicare for some, Medicare for more, Medicaid for all, “buy-ins,” Medicare for all) in The New York Times, here, while a Republican leader noted (here) that Democrats had “released a bill stripping all hard-working Americans of their health care freedom.” The Hill reports on centrist Democrats worried about Medicare-for-all (here), recommitted to fixing PPACA (here).
Claims Denials Vary Widely Among Exchange Plans, Average 20% of All Claims:
A Kaiser Family Foundation study (here) reports that there is “[H]uge variation across insurers, with average denial rates as low as 1 percent and as high as 45 percent. Denial rates also vary across states, though individual insurers in the same state also show wide variation. For instance, Florida’s six insurers denied 11 percent of claims, though the denial rates among the six insurers reporting data in the state range from 2 percent to 32 percent.” Denials are rarely appealed.
READING AND REFERENCE
National Center for Health Statistics, National Health Interview Survey, Health Insurance Coverage (here): “In the first 6 months of 2018, 28.5 million persons of all ages (8.8%) were uninsured at the time of interview—not significantly different from 2017, but 20.1 million fewer persons than in 2010. In the first 6 months of 2018, among adults aged 18–64, 12.5% were uninsured at the time of interview, 20.0% had public coverage, and 69.2% had private health insurance coverage. In the first 6 months of 2018, among children aged 0–17 years, 4.4% were uninsured, 43.4% had public coverage, and 53.6% had private health insurance coverage. Among adults aged 18–64, 69.2% (137.1 million) were covered by private health insurance plans at the time of interview in the first 6 months of 2018. This includes 4.0% (7.9 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges. The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan increased, from 43.7% in 2017 to 46.0% in the first 6 months of 2018.” Other parts of the survey results will be found here: https://www.cdc.gov/nchs/nhis/releases/released201812.htm
U.S. House of Representatives:
Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
April publication dates: 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.