3 Key Takeaways from AHLA’s Institute on Medicare and Medicaid Payment Issues

As I think about the healthcare industry and where we’re headed, I’m reminded of a lyric from the Tracy Lawrence song Time Marches On, “The only thing that stays the same is everything changes, everything changes.” Serious change is afoot and providers cannot just keep their heads above water. They have to find a way to thrive and flourish.

This week, I attended AHLA’s Institute on Medicare and Medicaid Payment Issues in Baltimore, MD, and I noticed there were some recurring themes in the sessions I attended:  

1. Medicaid Focus – Expansion, Reform, and Eligibility Simplification

Medicaid is the single largest public payer covering approximately 70 million people. With the passage of the ACA, there are currently 30 states plus DC that are part of the Medicaid expansion group. Louisiana is the most current due to the new governor signing an executive order but it has not gone into effect as of yet. Sixty percent of the Medicaid beneficiaries are enrolled in capitated, risk-based managed care arrangements, with Medicaid managed care growing. There is a proposed Medicaid managed care rule that contains new requirements that focus on accountability, transparency, and alignment with Medicare and the Marketplace. Even though there are lots of benefits, there will be many foreseeable challenges and unknowns. Not one size fits all because every state is different with Medicaid so a collective effort is most definitely needed.

2. Site-Neutral Payments

Site-Neutral Payments especially in regards to Section 603 of the Bipartisan Budget Act of 2015 seem to be what all the talk is about here.  Site-neutral payments are based either on (1) the patient or (2) the location of services. Section 603 is based on the location of services and is the beginning of significant changes to come. Jim Wadlington wrote a blog yesterday regarding this type of site-neutral payments which goes into more detail. The site-neutral payments based on patient is related to long term care hospitals (LTCHs). These newly introduced payments, which are being phased in this year, will affect 40% of current LTCH discharges according to MedPAC’s FY 2015 report to Congress.

3. Reporting is Crucial

Overall reporting of issues, overpayments, quality measures and so much more all come back to the provider having and bearing the ultimate risk. This holds true even if the provider did not cause the issue or overpayment in question. Providers must have the systems to track the required information as well as retain the information for a number of years. The rule authorizes Medicare Administrative Contractors (MACs) to reopen claims related to refunds for the 6 year lookback period. Document retention is very important for many reasons and regulations, especially for the 60-Day Report and Return Final Rule for Medicare Parts A and B.

With the healthcare world we are living in, this quote (often mistakenly credited to Charles Darwin) sums up the future of providers - “It is not the strongest of the species that survives, nor the most intelligent, but the one most adaptable to change.” - Leon C. Megginson

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