Healthcare Reform

Implementation of health care reform in 2013 has two main themes:

• Improving quality and lower costs
• Increasing access to affordable care

Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.  Click here to learn more about the law and preventive care.
   
Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.  For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.  It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program.


Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government.  Click here to learn how the law supports and strengthens primary care providers.

Providing Additional Funding for the Children’s Health Insurance Program. Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. This will be effective by October 1, 2013. Click here to learn more about CHIP.
(Information taken from HealthCare.gov)

Recovery Audit Contractors (RACs) audited $1.7 billion worth of Medicare claims and denied $86 million or 5.5% in 2010.  RACs also identified underpayments to hospitals totaling $17.4 million dollars.  Region C reports the highest level of RAC activity, with 556 hospitals reporting activity up to and including the first quarter of 2011.  In comparison, Region D (South Dakota's region) reports 423 hopsitals receiving reviews during that same period.

The American Hospital Association (AHA) collects and reports this and other valuable data from its web-based RACTrac survey.  1,960 hospitals have submitted data since the start  of the project in January 2010. Of that total, 84 percent reported RAC activity in the first quarter of 2011.  Of those reporting activity, approximately 16 percent were Critical Access Hospitals.  Of the claims that have completed the appeals process, 71 percent were overturned in favor of the provider, and 60 percent are still in the appeals process. In dollars and cents, this comes out to $8.6 million for overturned denials nationwide.

The AHA RACTrac report, which contains findings for 1st Quarter  2011, was released on May 20, 2011.