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Evan J. Albright

Contributing Editor

Contributing Editor Evan J. Albright is an award-winning writer with a lengthy resume in journalism, corporate communications, marketing, public relations, and advertising. In addition to his work with insideARM, Evan is a freelance writer, usually loaning out his pen as an executive ghostwriter. In his spare time he writes history, for peer-reviewed journals (most recently, “Three Lives of an African American Pioneer: William Henry Lewis 1868-1949” in Massachusetts Historical Review, Vol. 13, 2011), and for books and magazines (including the forthcoming Man Who Owned a Wonder of the World). Evan was born and raised in Oregon, and currently lives on Cape Cod in Massachusetts.

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Recent Posts

Media, Legislatures Take Aim at Healthcare Providers

Healthcare providers and their member organizations in the last year have taken more steps to reform patient billing than in the previous two decades combined, but that has not stopped the media nor lawmakers from continuing to pile on.

Television is currently in what are called “sweeps,” where local news pulls out all stops to attract viewers. Expect to see plenty of stories about some hapless individual who unexpectedly receives a giant medical bill. For example, KPNX, the NBC affiliate that is co-owned by the Arizona Republic newspaper, completed a seven-part news special report covering the more alarmist aspects of healthcare bills and their impact on consumers.

Number of Americans Having Trouble Paying Medical Debt Falls

The percentage of U.S. residents who reported having trouble paying medical debt fell between 2011 and 2013, according to an interim report by the Centers for Disease Control.

The CDC’s Division of Health Interview Statistics, a department in the National Center for Health Statistics, found that nearly five million fewer U.S. residents reported problems with medical debt in the first six months of 2013 versus the same period in 2011. The CDC projects that 52.8 million persons in 2013 experienced difficulty with medical expenses owed versus 57.6 million in 2011.

Managing Patients Who Are Uninsured-by-Choice

While one in 10 individuals living in the United States do not qualify for health insurance by way of the Affordable Care Act, there is a large number of Americans who, by choice, have elected to forgo health insurance even though it is available to them.

For healthcare providers, the uninsured-by-choice represent a missed opportunity, but while the door is closed to 2014, the time is now to educate your self-pay population in preparation for the 2015 enrollment period.

CMS Mum on ICD-10 Postponement

Even though President Barack Obama signed into law postponement of ICD-10 implementation to Oct. 1, 2015, the Centers for Medicare and Medicaid Services (CMS) has yet to take official action.

Nearly three weeks after Congress passed the bill and the president signed it CMS has so far only made a small change to its official website on ICD-10, acknowledging the new deadline by merely quoting the text of the bill.

“With enactment of the Protecting Access to Medicare Act of 2014, CMS is examining the implications of the ICD-10 provision and will provide guidance to providers and stakeholders soon,” the website states.

Healthcare Spending Jumps, Can Providers Expect a Boom?

Patient spending and consumption of healthcare services and medicines increased in 2013, according to a new study.

The IMS Institute of Healthcare Informatics published its annual survey of healthcare consumption this month, and found that in 2013 overall spending on healthcare services in some categories experienced double digit growth, although some areas, such as emergency room services, declined.

If the research is correct, the trend of increased consumption of healthcare services began well before the individual insurance mandate and Medicaid expansion took effect.

RACs Rake in More than $2 Billion from Healthcare Providers

The Centers for Medicare and Medicaid Services (CMS) released its annual appraisal of Recovery Audit Contractors (RACs), and as will come to no surprise to any healthcare provider, the four agencies found more than $2 billion in overpayments.

The new report covers Fiscal 2012, which ended Oct. 1, 2013.

The difference between Fiscal 2011 and 2012 is startling. In 2011, RACs found slightly less than $800 million in overpayments; in 2012 that skyrocketed to nearly $2.3 billion, nearly trebling the previous year. At the same time, the number of errors found in favor of providers dropped precipitously, from $142 million in overpayments in 2011 to only $109 million in 2012.

CMS Continues to Tinker with ‘Two-Midnight’ Rule

The Centers for Medicare and Medicaid Services continue to refine application of the “two-midnight rule,” the new standard for whether a Medicare beneficiary should be considered “inpatient” under Medicare Part A or “observation status” under Medicare Part B.

CMS last month updated its “two-midnight rule FAQ” to to cover circumstances where a patient is admitted to a hospital for a surgical procedure, but that procedure is cancelled. According to CMS, the claim can be submitted under Medicare Part A, provided proper documentation is in order (a copy of the text appears below).

The clarification only pertains to Medicare Administrative Contractor (MAC) reviews of claims. With regard to Recovery Audit Contractor (RAC) reviews, claims submitted under the two-midnight rule are exempt from scrutiny, except in cases where fraud or malfeasance is suspected.

The Future of Bad Debt: The American Worker with Employer Health Insurance

American workers with access to health insurance from their employers were among the lowest financial risks to healthcare providers. No more, according to trends identified in two recent reports.

Zywave, a software company that serves health insurers, and ADP, a payroll company, have crunched the numbers of their respective client bases and identified a series of trends that pose high risk to the bottom line of healthcare providers.

Thanks, no doubt to the Affordable Care Act which soon will limit an individuals out-of-pocket medical expenses to $6,350 ($12,700 for a family), employers appear to be rushing to match that figure with their employee health insurance programs.

It’s the Law: President Signs Quick Fix to SGR

President Barack Obama signed into law the quickie bill that reversed the sustainable growth rate (SGR) cut of 24 percent to Medicare reimbursements to the nation’s physicians.

The bill also postponed implementation of ICD-10 for one year to Oct. 1, 2015, and extended the moratorium on Medicare Recovery Audit Contractors (RACs) from reviewing claims submitted under the controversial “two-midnight rule” for six additional months for a period to extend from Oct. 1, 2013 to April 1, 2015.

According to media reports, the bill, which originated in the House of Representatives, was passed by way of legislative sleight of hand, and conservatives in the House were outraged. Conservatives reportedly had been told there would be no vote on the bill, but Congressional leadership apparently snuck the bill through the House by a voice vote.

Congress Postpones ICD-10 to October 2015

All it took was one sentence, but Congress approved postponing implementation of ICD-10 another year to Oct. 1, 2015.

The delay was slipped in to a bill temporarily fixing the sustainable growth rate (SGR) cuts that have, on paper, gone into effect today. If President Barack Obama signs the bill, a scheduled 24 percent cut in Medicare reimbursements to physicians that is to start April 1 will disappear.

Congress threw in another bonus to healthcare providers, specifically hospitals, by ordering the director of the Centers for Medicare and Medicaid Services to extend the ban on Recovery Audit Contractors (RAC) audits on claims filed under the “two-midnight rule” another six months to April 1, 2015. RACs currently are prohibited from auditing inpatient claims under the two-midnight rule from Oct. 1, 2013 to Oct. 1, 2014.