Midweek update

The Congressional Budget Office issued its March 2015 baseline report on the ACA last Monday.  Here’s a Modern Healthcare perspective on the report. The FEHBlog was surprised that compared to the January benchmark CBO lowered the Cadillac tax’s projected revenue over the period 2016 – 2025 by $62 billion to $87 billion. This shows that employers are actively pursuing their options to lower their tax liability, e.g., by switching to consumer driven plans. The chances of repealing the Cadillac tax increase as the revenue projection drops.

The FEHBlog discovered yesterday in this iHealthbeat article that late last month, CMS issued a notice to providers advising that Medicare will not process claims with ICD-9 codes for dates of service after September 30, 2015 — no dual processing. A separate set of rule applies for hospital stays that begin before October 1 and end on after October 1 as explained in the CMS notice. This simplifies matters for health plans which generally take their lead from CMS on coding issues. However, you never know whether Congress will require a CMS dual coding accommodation to providers. Time will tell.

Fierce Healthcare reports that CMS has release information on a next generation version of accountable care organizations. The new model is intended to allow “participants to take on more financial risk with more predictable financial targets and the potential to obtain a greater reward.” Again time will tell.

Avoiding hospital readmissions has been an OPM objective for the FEHBP. Medscape reports on a study finding that “Hospital readmissions were significantly reduced when patients with multiple chronic conditions and a greater than 20% baseline risk for readmission received follow-up within 7 days of discharge, according to a study of 44,473 Medicaid recipients in North Carolina with 65,085 qualifying discharges.” “Better patient support = fewer readmissions” makes sense to the FEHBlog.

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