Earlier this year, the Medicare Payment Advisory Commission (MedPAC) uninamously voted to recommend removing “incident to” Medicare billing for advanced practice registered nurses (APRNs) and physician assistants (PAs). MedPAC serves as an independent congressional agency that advises Congress on Medicare-related issues by analyzing access and quality of care. If this recommendation is adopted, APRNs and PAs would only be able to bill Medicare directly, thus reducing the amount paid by Medicare from 100% under services billed “incident to” to 85% directly. This recommendation could potentially save the Medicare program up to $250 million annually and would allow for better data collection into the amount of services performed by APRNs and PAs, whose services are often masked under “incident to” billing reports. Though there is still some debate on whether the financial loss of losing this option is too high for primary physicians who may hire APRNs and PAs for their practice, the benefits of billing directly likely outweigh the losses.
The Centers for Medicare and Medicaid Services (CMS) have a multitude of resources to detect and protect against fraud and abuse in claims. Particularly, CMS has at least six types of contractors that provide different roles in the prevention, detection, and reporting of fraud and abuse in healthcare. This list includes Recovery Auditors, which serve to reduce fraud and abuse by detecting and collecting overpayments from entities and Comprehensive Error Rate Testing (CERT) Contractors, which determine rates of improper payments by reviewing claims under Medicare Fee-For-Service (FFS). Another auditor that providers should be particularly mindful of are the Zone Program Integrity Contractors (ZPICs). This article is an overview ZPICS, its role in Medicare, and outlines the steps providers should take when faced with an audit by ZPICs.
Across the United States more and more women are choosing to give birth outside of hospitals. Currently, in Illinois, Certified Professional Midwives are not licensed to provide home birth services. However, over the last decade, advocates in Illinois have urged lawmakers to reconsider this restriction. The most recent attempt in 2017 was unsuccessful once again. While opponents argue that individuals with this level of training should not be providing care to women during delivery, the choice for women who are committed to home birth is not between home and the hospital. It is between home and an illegal or unassisted delivery.
The Trump administration has established a new division within the Department of Health and Human Services (HHS) called the Conscience and Religious Freedom Division. The stated purpose of this office is to “restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom.”
One day after the creation of this division, HHS proposed a new rule, providing further protections to healthcare workers who object to providing certain types of care to patients—including elective sterilization, gender reassignment surgery, or emergency contraception—based on their personal religious beliefs. Additionally, the Trump administration issued a new directive, reversing an Obama administration directive which prohibited states from refusing to send federal funds to qualified providers. This new division, new rule, and new directive serve to ensure the already-existing rights of physicians, nurses, and healthcare staff at the expense of their patients.