Health Reform Provision Cuts Red Tape—and Costs—for Senior Care Providers

some standards that have recently been introduced for electronic funds transfers in healthcare through the Obama Administration’s Affordable Care Act will reduce up to $4.5 billion off administrative costs for healthcare providers, including doctors and hospitals and private and government health plans, says the U.S. Department of Health and Human Services.

This cost reduction is according to estimates included in new rules that the HHS published on Jan. 5, 2011, and the two regulations that implement the Administrative Simplification provisions of the ACA and the Health Insurance Portability and Accountability Act are projected to save the healthcare industry more than $16 billion in the next decade.
“Thanks to the Affordable Care Act, health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients,” said HHS Secretary Kathleen Sebelius in a statement.
Last year, a study published in the Health Affairs journal found that for every dollar a physician receives from patients, 12% goes to cover the costs of filling out forms and performing other “excessively complex administrative tasks,” reports the HHS. However, simplifying these systems could save four hours per week of professional time for each physician, along with five hours of support staff time, the study found.
The rule, “Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice,” adopts “streamlined standards for the format and data content of the transmission a health plan sends to its bank when it wants to pay a claim to a provider electronically and to issue a Remittance Advice notice,” says HHS.
Sometimes, the Remittance Advice (a notice of payment sent to providers) doesn’t accompany the payment the provider receives, and in instances where it’s separate from the Electronic Funds Transfers payment, the disconnect makes it difficult for the provider to match up the bill and the corresponding payment.
“Today’s rule addresses this by requiring the use of a trace number that automatically matches the two,” says HHS. “The new tracking system will allow healthcare providers to eliminate costly manual reconciliation that must currently be done.”
Interim Final Regulations can be viewed here.
Written by Alyssa Gerace

Health Care Law ruling

 U.S. Supreme Court rules on the health care law sometime between the end of March, when arguments are scheduled over three days, and June, when the court typically issues its final opinions for each term.   w

MASS HEATH CARE INSURANCE

The poll results show that residents with incomes below $30,000 — the bracket that would probably make them eligible for state-subsidized care — were the most likely to say the law is helping to control the cost of their care.


The law expanded eligibility for subsidized coverage to thousands more residents, and state figures a year after the law went into effect showed that more than 200,000 residents were added to state-run coverage.


The poll results also showed that the highest income group, those whose income exceeds $75,000, were more likely than the lowest income group to say the law is hurting their health costs.


Kay Lazar can be reached at klazar@globe.com.

uninsured coverage Mass Free Medical Care

Gov. Deval Patrick yesterday shrugged off a scathing inspector general’s report that found costly loopholes in the state’s $414 million free health-care pool — as Republicans pushed to put the brakes on the program.

“The depth of the issues is not as great as first read,” Patrick said of the report during the “Ask the Governor” segment on “Jim and Margery” on WTKK-FM (96.9).

The Herald this week reported that according to the IG probe, the state’s free medical care program — designed to help low-income uninsured Massachusetts residents — spent $7 million on hospital and doctors’ bills for out-of-staters and foreigners, and $6 million on duplicate claims.



“I venture to say that some of these issues might be a little exaggerated. That doesn’t mean to say an isolated incident isn’t significant,” Patrick said.

The IG’s office responded in a statement saying that because the administration had “failed to implement a claims adjudication system for outpatient claims . . . the Office commissioned its own claims editing adjudication.”

The office hired “an experienced health-care provider claims adjudication company,” Senior Assistant Inspector General Jack McCarthy said. “This vendor followed all Massachusetts laws and regulations.”

The report was hand-delivered to Health and Human Services Secretary JudyAnn Bigby on March 3, McCarthy said.

Meanwhile, Senate Minority Leader Bruce Tarr (R-Gloucester) and state Sens. Robert Hedlund (R-Weymouth), Michael Knapik (R-Westfield) and Richard Ross (R-Wrentham) called for better verification of applicants’ Medicaid eligibility, improved safeguards to prevent duplicate payments or payments for medically unnecessary procedures, and an audit of the state’s Medicaid program by the inspector general.

“We find it extremely troubling to learn there are such lax procedures in place that have allowed so many people to take advantage of the system,” Tarr said. “When health-care costs continue to grow at an unsustainable rate, we simply cannot allow such waste and abuse to continue.”

Tarr yesterday filed three amendments to the state’s 2011 supplemental budget to crack down on flaws in the system. The amendments failed last night.

“It’s deeply troubling that, in face of overwhelming evidence that health-care dollars are being spent appropriately, we failed to take action,” said Tarr, who scoffed at the majority party’s suggestion that safeguards are already in place. “If that’s the case, why was this report released?”

Hillary Chabot and Laura Crimaldi contributed to this report.

free care under healh care reform

We share the inspector general’s commitment to finding ways to enhance and improve the integrity of the claims adjudication systems at the Health Safety Net,” said Paulette Song, a spokeswoman for JudyAnn Bigby, secretary of the state’s Executive Office and Health and Human Services, “and are reviewing the 2011 report thoroughly to find opportunities to help increase efficiencies.”

Perhaps the report’s most troubling finding is that the state relies on the honor system when determining who is eligible for free care — and does not review an applicant’s assets, or even require a Social Security number to verify income, citizenship or address, Sullivan said.

This week marks the one-year anniversary of the Affordable Care Act.

Millions of Americans are already benefitting from our new health reform law. In the months ahead, even more of us will benefit if it improves care coordination, provides more preventive services, and makes coverage more affordable and secure. It only gets better from here.

That is, if we give reform time to work — and work together to make sure it gets implemented effectively.

Together, we’re working to build better care — care that is better coordinated, more centered on meeting the needs of patients, and more affordable. That's why I'm asking you to encourage the Senate to stand strong against efforts to repeal or defund health reform.

It’s time to move forward and fix our health care system.

We simply can’t afford to let anyone undermine our efforts to make America’s health care system work better for all of us — and especially for older adults, patients with multiple chronic conditions and their family caregivers.

Just ask Leslie Schlienger, a nurse from south Florida, who is working on the front lines.


Since graduating from nursing school in 1980, Leslie has been a head nurse in Veterans Administration and community hospitals, earned her certification in rehabilitation nursing and her master’s degree in nursing administration. For the last dozen years she’s been a home health nurse, and a critical part of her work is coordinating clients’ care with family, friends and medical professionals.

"The fragmentation of how care is delivered is a big issue," Leslie says. "Because of all the specialties, a single patient often has two or three physicians, and I’ve seen some with as many as seven or eight. Patients are overwhelmed by that. They’re lost in that system." (Read the rest of Leslie's story here.)


Now more than ever, we need better care coordination, improved communication among providers, medical records at our fingertips, and a system that doesn’t leave vulnerable patients and their family caregivers to fend for themselves.

To mark the one-year anniversary of the Affordable Care Act and honor the millions of Americans working every day for better care, urge your Senators to focus on fixing our health care system and reject any attempts to repeal or defund health reform.

I’ve already sent my message to Congress. Please send yours now!

Sincerely,

Medicare Advantage

Improvements to Medicare Advantage • Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. These additional payments are paid for in part by increased premiums by all Medicare beneficiaries—including the 77% of seniors not enrolled in a Medicare Advantage plan. • The new law levels the playing field by gradually eliminating Medicare Advantage overpayments to insurance companies. • If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits. • Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs and insurance company profits.