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Reimbursement

Dec 11, 2008 Natalie Klotsche
in

California hospitals’ revenue stream is critical to their overall mission of providing care and cures in the communities they serve. While over half of hospitals' revenue, nearly $30 billion a year, is derived from government-funded programs, including Medicare, Medi-Cal, Healthy Families and county indigent programs - Private Insurance revenues are also significant.

CMS to Hold Claims Payable Under Physician Fee Schedule for 10 Days in January 2010

Dec 22, 2009 John Rigg
in
Agency holding claims in anticipation of corrective legislation being signed by President Obama

The Centers for Medicare & Medicaid Services (CMS) announced on December 21 that they will be holding all claims payable under the Medicare physician fee schedule (MPFS) for the first ten business days of January (January 1 to 15).  The agency claims that this hold will not result in any delayed payment to providers, and is intended to diminish any disruption caused by the statutorily-

Governor Signs Hospital Fee Appropriations Bill

Dec 2, 2009 Anne McLeod
in

The Governor signed AB 188 (Jones, D-Sacramento/Alquist, D-Santa Clara/Steinberg, D-Sacramento) on Nov. 5. Co-sponsored by CHA, the bill provides the necessary appropriations for the state to seek federal approval to implement AB 1383 (Jones, D-Sacramento/Alquist, D-Santa Clara). AB 1383 assesses a fee on hospitals for the purpose of securing matching federal funds to make supplemental Medi-Cal payments to hospitals and to provide the state with $320 million in annual funding for children's health care coverage.

Lawsuit Filed on Medi-Cal 340B Changes

Dec 2, 2009 Anne McLeod
in

The AIDS Healthcare Foundation (AHF) filed a complaint this week against the Department of Health Care Services (DHCS), seeking an injunction to prevent the implementation of the new state law aimed at 340B providers.

CMS Issues Final Rule on Recoupment of Medicare Overpayments

Sep 24, 2009 Natalie Klotsche
in

CMS Issues Final Rule on Recoupment of Medicare Overpayments
The Centers for Medicare & Medicaid Services (CMS) issued a final rule in the Federal Register this week that implements a provision of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The rule prohibits Medicare from recouping overpayments from a provider that is pursuing an appeal from a Qualified Independent Contractor (QIC).

Commission on Health and Safety and Workers' Compensation

Sep 17, 2009 Natalie Klotsche
in

The Commission on Health and Safety and Workers’ Compensation (CHSWC) has released reports for circulation and public comment:

Hospital Emergency Department Services Furnished under California’s Workers’ Compensation Program

This paper examines hospital emergency room services received by injured workers. It uses the OSHPD data for 2005-2007 to explore whether there might be payment or quality of care issues for California workers’ compensation patients.

H1N1 Vaccine - Billing and Coverage Information

Sep 9, 2009 Natalie Klotsche
in

In anticipation of the availability of a vaccine for the H1N1 virus in the fall of 2009, the Centers for Medicare & Medicaid Services (CMS) created two new HCPCS Codes for the vaccine itself (G9142), which is not payable by Medicare as it will be supplied at no cost, and for the administration (G9141), which is payable. The effective date of G9142 and G9141 is September 1, 2009.