Articles on the implementation of ObamaCare.
“House Ways & Means health subcommittee chair Kevin Brady (R-TX) questions HHS’ authority to settle hospitals’ appeals of denied inpatient claims and is urging HHS Secretary Sylvia Burwell to retract what he views as an “ill thought” settlement process. Brady wants Burwell to work with lawmakers to come up with a different “fair, transparent and conclusive settlement process.”
Brady wrote to Burwell Tuesday (Sept. 16) that he is dismayed by HHS’ reluctance to work with the committee on an equitable settlement process that is fully legal, adding that the “lack of engagement makes it challenging for the Congress to solve the current appeals problems and prevent similar problems in the future.”
CMS announced late last month (Aug. 29) that it will pay hospitals 68 percent of denied inpatient status claims in the appeals queue if hospitals take them out of the backlogged appeals process. The agency has been encouraging hospitals to take advantage of the settlement to “alleviate the burden of Medicare appeals on both the hospital and Medicare systems,” according to the CMS website.
Hospitals should decide whether to participate by the end of October, and CMS in a Frequently Asked Questions document released Sept. 9 says that four hospitals have already stepped forward to take the settlement offer. The document also states that this is a one-time offer from CMS.”
“Last year I wrote that Obamacare could leave doctors holding the bag for claims for patients who don’t pay their insurance premiums. That’s because the law includes a three-month grace period during which health insurers must continue to cover patients who sign up, but don’t pay the price of their insurance. If the patients eventually make good, there’s no problem. But if patients don’t pay the owed premiums, the insurance company has to cover the cost of claims filed during the first month. Providers are stuck with the tab for any claims filed during months two and three.
The piece I wrote last July was theoretical. The notification letter I’m holding in my hand, addressed to my wife’s pediatric practice, is reality. And reality costs, in this case, over $600. That’s the outstanding balance owed the practice by a patient insured by BlueCross BlueShield of Arizona. It’s a balance that my wife might have to eat, or else try to collect herself.”
“There are widespread instances of Obamacare insurance plans violating the rigid rules surrounding whether customers can use federal health care subsidies on insurance policies that cover abortion procedures, according to a Government Accountability Office investigation.
The report, commissioned by House Republican leadership and obtained by POLITICO on Monday night, found that 15 insurers in a sample of 18 are selling Obamacare plans that do not segregate funds to cover abortion (except in cases of rape, incest or the mother’s life) from their Obamacare subsidies.
“During the 2014 open enrollment for Obamacare coverage, Mary Denson, 21, a student at Columbia (Mo.) College, qualified for a federal premium subsidy that reduced her premium contribution for buying health insurance to less than $20 a month.
But she fears that when she renews her coverage for 2015, she won’t have enough income from her nanny job to reach the subsidy income threshold of 100% of the federal poverty level and continue qualifying for premium tax credits. She isn’t eligible for Medicaid because Missouri hasn’t expanded that program for low-income adults. Denson says she’s considering looking for another job to reach the $11,670 income threshold but worries she may have to drop classes. Without the subsidy, her coverage would cost nearly $400 a month, far more than she can afford.
“I’m just going to have to re-apply and pretty much hope that I make the cut again,” Denson said.”
“States have developed various ways to avoid paying their fair share of Medicaid expenses over the years, in some cases costing the federal government hundreds of millions of dollars in extra funding for the program.
The Department of Health and Human Services, which runs Medicaid through its Centers for Medicare and Medicaid Services (CMS), has known about the issue for more than a decade, but states still find ways to game the system. The agency’s inspector general this year listed the issue among 25 key problems the agency needs to address.”
“When it comes to claims about Medicare, some political talking points just never die.
In Iowa and Virginia, Republicans have accused Democrats of cutting Medicare to pay for Obamacare. In Florida, a Republican was slammed for ending the Medicare “guarantee.” Other Medicare-related attacks have been deployed in Arkansas and Kentucky Senate races. The point of all the attacks is to convince midterm voters that one side or the other won’t protect the program.
Take this one, used in a recent ad aired by the National Republican Senatorial Committee in the hotly contested Iowa Senate race between Democratic Rep. Bruce Braley and Republican state Sen. Joni Ernst:
“Bruce Braley voted to cut $700 billion from Medicare to support Obamacare,” the ad says. “That’s just not fair. We paid in. We paid for it. That should be there for us.””
“Last week, we finally learned the prices for the new benchmark plans for Obamacare. The good news: Prices are falling slightly. The bad news: Contrary to optimistic early reports, that doesn’t mean that everyone’s costs are falling; consumers will have to be attentive to make sure that their costs don’t go up. The worse news: We won’t actually know what effect the Affordable Care Act is having on insurance prices until 2017, when a bunch of temporary subsidies for insurers expire.
The important thing to keep in mind is that when the “benchmark rate” goes down, that doesn’t mean that the cost of the old benchmark plan has fallen. It just means that whatever plan is now the second-cheapest “silver” plan on the exchanges is cheaper than whatever was the second-cheapest plan last year.”
“Potential complications await consumers as President Barack Obama’s health care law approaches its second open enrollment season, just two months away.
Don’t expect a repeat of last year’s website meltdown, but the new sign-up period could expose underlying problems with the law itself that are less easily fixed than a computer system.
Getting those who signed up this year enrolled again for 2015 won’t be as easy as it might seem. And the law’s interaction between insurance and taxes looks like a sure-fire formula for confusion.”
“CVS Health is investigating a potential glitch in its drug pricing system that appears to have charged women copayments for prescription birth control – though the scope of the error is unclear.
The problem came to the attention of Rep. Jackie Speier, D-Calif., after one of her staffers attempted to buy generic prescription birth control in Washington D.C. and was charged a $20 copay.
The retailer’s error, highlighted in a letter to the company from Speier, runs counter to a provision of the federal health law that mandates insurance coverage of women’s preventive care – a category including generic prescription birth control – without cost sharing.”
“House Republicans on Thursday returned to the Obamacare well for another vote against the law, this time to allow consumers to stay on once-canceled plans until 2019.
The House approved the bill, 247-167, with the support of all Republicans and 25 Democrats. It was the first vote on the health care law since April.
The bill, targeted at President Barack Obama’s promise that consumers would be able to keep their health plans under his signature health law, was sponsored by Rep. Bill Cassidy, who is in a tight race to unseat Democratic Sen. Mary Landrieu in Louisiana.”