Sep 24, 2018 | Legislation/ Budgets/ Macro
On September 18th, Senator Bill Cassidy (R-LA) released bipartisan draft legislation that aims to protect patients from receiving surprise medical bills for care received in an emergency department. This practice, also called balance billing, is when a healthcare provider bills the patient for the difference between what the patient’s insurance pays and what the provider charges, oftentimes resulting in patients having to pay medical bills worth thousands of dollars. This brief outlines the provisions included in the discussion draft, currently called the Protecting Patients from Surprise...
Sep 12, 2018 | Medicaid, Medicare, Payers
In this report, BRG expert Dr. Henry Miller analyzes the effect of having two large integrated financing and delivery systems on healthcare costs in the Pittsburgh metropolitan area. The analysis compares Pittsburgh MSA data to US national cost data as well as cost data for other large MSAs across the country. Health insurance premiums for family coverage, Medicare expenditures per beneficiary, and hospital costs are all included in the report’s analysis. Click here to read more.
Sep 5, 2018 | Legislation/ Budgets/ Macro, Medicaid
After failed attempts by Republicans in Congress to repeal and replace the ACA in 2017, attempts to expand Medicaid in several states have gained momentum. Virginia already expanded coverage in June, and several states could expand coverage in the near term depending on elections and voter referendums set to take place this November. In this brief, we discuss recent developments regarding Medicaid expansion. Click to read more.
Aug 28, 2018 | DMEPOS, Physician Fee Schedule, Physicians, Substance Abuse
Every year, CMS releases Comparative Billing Reports (CBRs) to about 10-12 provider groups. CBRs are issued in the form of letters sent to individual providers which analyze and compare individual provider billing patterns with other similar providers in their state and nationally. Typically, CBRs are inspired by past or pending OIG reports or other concerns raised about basic billing patterns, so they effectively put providers on alert that their specialty is being given extra attention, and makes them aware if they are outliers among billers in their specialty. In this brief, we have...
Aug 23, 2018 | Ambulance, Ground, Home Health
CMS recently extended regulations preventing enrollment of new home health agencies and Part B ground ambulance suppliers in Medicare and Medicaid, for specific geographies across the country. Since first being implemented in 2013, the moratoria have been extended and expanded every 6 months to date. In this brief, we highlight the existing moratoria and look at CMS market saturation and utilization data, which provides insights as to why such restrictions exist in certain areas. Click to read more.
