Updated on: November 29, -0001

Now Let Me Get This Straight…

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Original story posted on: April 14, 2014

It has been quite a winter and spring, hasn’t it? We really are feeling the effects of the Patient Protection and Affordable Care Act (PPACA)!

First, the Centers for Medicare & Medicaid Services (CMS) gave us the inpatient changes for 2014, chief among them being:

  1. The uncompensated care payment (taking money from hospitals with high Medicaid and SSI workloads and giving it to hospitals that can’t, or won’t, manage their bad debts); and

  2. The extension of the “quality reporting” 2-percent payment penalties to pretty much everyone except physicians.

Next came the 2014 outpatient changes. Oh, there was some great stuff there, to name just a few:

  1. One E&M code for clinics;

  2. Clinical labs not being paid on a TOB 12X or 13X;

  3. All the things that function as supplies in a procedure or diagnostic test being “bundled;” and

  4. Mod-FB and Mod-FC going away, and being replaced by VC-FD.

Yet Another Law

This brings us to April 2, 2014, when President Obama signed the “Protecting Access to Medicare Act of 2014” into law. Most of us know the key points, but what else was included in this little patchwork quilt of a law?

Physician Payments

To begin, it stopped a massive reduction in physician payments (for, like, the 20th time), which was necessary because a Congress of 20-odd years ago thought it would be smart to cut physician payments by 20-30 percent across the board. It wasn’t.

But subsequent administrations haven’t been motivated to fix the problem, so every year we have a delay. This one is good until April 1, 2015. You can think of it as a 20-year-old, auto-renewing temporary fix.

Funding Extensions

Many programs were to be funded at lower levels this year. After all, someone must pay for the PPACA! So the following things (I love technical terms) are being refunded (that is, being funded as they were in 2013, rather than being reduced):

  • Ambulance

  • Low-volume hospitals

  • Medicare-dependent hospitals (heck, they actually went away, but they’re back)

  • Specialized Medicare Advantage plans for special-needs individuals

  • “Reasonable cost” contracts

You get the idea: Most of the PPACA savings have been neutralized.

Other Extensions

Well, let’s see:

  1. The two-midnight rule was delayed, and

  2. The Medicaid and CHIP “express lane option” continues, as do:

  • The special diabetes program for Type 1

  • Abstinence education

  • The Personal Responsibility Education Program (PREP) (I wouldn’t make this up)

  • Family-to-family information centers (What?)

  • Maternal, infant, and early childhood home visiting programs

  • Pediatric quality measures (So, Medicare is dictating pediatric quality measures…)

And Then There’s Section 212:

Oh, yes, before I forget: ICD-10 is delayed for at least a year. The law doesn’t say it’s delayed until Oct. 1, 2015; it says CMS cannot order it before Oct. 1, 2015. And doesn’t “Section 212” sound somewhat sinister?

The Future

Finally, there are a couple of things that are “far out, man!” – that is, far out into the future. Where’s a DeLorean when you really need one??

First, skilled nursing facilities (SNFs) are going to savor value-based purchasing starting in 2016.

Then there’s sequestration! Most of us hoped it would end with this year’s budget and this law, but no such luck. In fact, Section 222 (not to be confused with Section 212) actually indicates that the sequester reduction will be 4 percent for the first six months of each year and 0 percent for the last six months of each year, beginning in 2024.

Yes, 2024.

I know, right?

To Conclude

There are a lot of other nitpicky things in this bill, and it was somewhat shocking to see they could put so much shortsighted thinking in a double-spaced document that was only 126 pages long. But they did.

Go figure.

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.