blackburn group inc.

MSA News - The 2014 Medicare Trustees Report, and the ICD-10 Ruling

The 2014 Medicare Trustee Reports shows improvement and sustainability past 2026, perhaps until 2030 under the current guidelines and utilization rates. Also, HHS issues their final ruling regarding the ICD-10 implementation date.

While Medicare spending per beneficiary is currently projected to grow at a slower rate than private insurance, it faces significant challenges due to the significant increase in the number of baby boom beneficiaries.

Proponents say the Affordable Care Act (ACA) provides for opportunities to contain costs and promote access to quality health care. Some of the potential quality outcome and cost containment factors include coordinated care through Accountable Care Organizations, bundled payments, and reducing hospital readmissions and hospital-acquired infections. Fraud, waste and abuse efforts will also establish a culture of compliance and enforcement of the guidelines.

In addition, the effort to reduce the rate of reimbursement to providers for a "fee for service" payment model will provide the greatest impact in overall cost containment. New payment systems based upon better outcomes for the most chronic and costly beneficiaries will help drive lower costs.

Medicare would also benefit by being able to negotiate Part D drug rebates and prescription drug prices as they were able to do prior to the Medicare Moderization Act. The Congressional Budget Office (CBO) has estimated savings of $141 billion over 10 years if drug manufacturerswere required to provide rebates for drugs used by low-income Medicare beneficiaries.  Click here for more information from The 2014 Medicare Trustees Report >>

In a separate administrative ruling on July 31, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to organize their operations to ensure their systems and business processes are ready to go on October 1, 2015. Click here for more about the HHS ruling regarding ICD-10 >>



Blackburn Group, Inc.   RiskPro® is a registered trademark of Blackburn Group, Inc.