Americans are living longer due to several medical advances, but unhealthy behavior and preventable illness threaten quality of life, according to United Health Foundation’s 2012 America’s Health Rankings®.
FAIR Health® Offers Researchers First-Time Access to Nation’s Most Comprehensive, Independent Medical and Dental Claims Information | Business WireJuly 21, 2012
FAIR Health, the independent not-for-profit corporation dedicated to bringing transparency to healthcare costs and out-of-network reimbursement, has launched the FAIR Health Research Support Program, designed to provide academic researchers unprecedented access to its national healthcare claims database, the FAIR Health National Private Insurance Claims (FH NPICSM) Database.
“We expect the need for data to continue to grow as researchers realize the power of the information available to them through the FH NPIC Database and continue to ask important questions about the healthcare system.”
The FH NPIC Database currently includes more than 14 billion billed claims for medical and dental procedures performed since 2002 by healthcare providers nationwide. Data are submitted by more than 70 private payors participating in the organization’s data contribution program who collectively insure over 125 million covered lives, representing the most comprehensive private healthcare claims database available. Researchers will be able to license the FAIR Health data for research purposes. More information about the FH NPIC database and the Research Support Program generally is available at research.fairhealth.org.
This publication highlights the principal features of social security programs in more than 170 countries. Published in collaboration with the International Social Security Association, one of four regional volumes is issued every six months.
The true costs of ObamaCare continue to rise, as budget projections under the healthcare law are being understated by as much as $50 billion per year, according to a new report from Cornell economist Richard Burkhauser and his colleagues from Cornell and Indiana University. This alarming revelation is due to official budget forecasts that neglect to account for employees’ spouses and children — which could result in hundreds of billions more in taxpayers’ dollars over the next 10 years. “The Congressional Budget Office has never done a cost-estimate of this [because] they were expressly told to do their modeling on single [person] coverage,” Burkhauser alleged. “A very large number of workers” will have access to federal subsidies, “dramatically increasing the cost” of ObamaCare.
The Elements of the Health Care Compact
Pledge: Member states agree to work together to pass this Compact, and to improve the health care in their respective states.
Legislative Power: Member states have primary responsibility for regulation of all non-military health care goods and services in their state.
State Control: In member states, states can suspend federal health care regulations. Federal and state health care laws remain in force in a state until states enact superseding regulations.
The federal government wasted almost $48 billion in improper payments in Medicare last year, the most of any government program, federal officials testified Thursday.
The Government Accountability Office (GAO) released a new report Thursday to coincide with a hearing of the House Oversight Committee’s panel on government efficiency. The report found that the Health and Human Services Department has been making progress in cutting back on improper payments, but has a long way to go.
CRS | Medicare Program Integrity: Activities to Protect Medicare from Payment Errors, Fraud, and AbuseAugust 4, 2011
Since 1990, the Government Accountability Office (GAO) has identified the Medicare program as at risk for improper payments and fraud, and, since 2004, has issued 12 products documenting various program vulnerabilities. As noted by GAO and other public and private analysts, Medicare’s vulnerability to fraud and abuse arises from the program’s size, complexity, decentralization, and administrative requirements. Although a good estimate of the dollar amount lost to Medicare fraud and abuse is open to discussion, analysts agree that billions of dollars are lost. Administering the volume of claims (more than 4.5 million per work day) from Medicare’s many providers and suppliers (over 1 million) is a daunting task. Requirements to process and pay provider reimbursement claims quickly, have set up a “pay and chase” approach that complicates program integrity efforts.
GAO | PATIENT PROTECTION AND AFFORDABLE CARE ACT IRS Should Expand Its Strategic Approach to ImplementationJuly 1, 2011
In summary, IRS has responsibilities in the implementation of 47 PPACA provisions with effective dates through 2018.2 In planning to implement these provisions, IRS has generally followed leading practices. Top leadership has been involved; cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; work has started on compliance controls; and risks are being identified and analyzed at the individual project level. However, IRS could improve aspects of its planning, particularly at an agencywide or strategic level. IRS defines strategic-level goals and project plans in multiple documents without integrating the goals or plans, IRS has no timeline for developing performance measures and collecting associated data, a cost estimate for all of the PPACA program has not been provided, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed. While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems.
GAO | MEDICAID AND CHIP Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty CareJuly 1, 2011
Most physicians are enrolled in Medicaid and CHIP and serving children covered by these programs. On the basis of its 2010 national survey of physicians, GAO estimates that more than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs. A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent). Further, a larger share of rural primary care physicians (94 percent) are participating in the programs than urban primary care physicians (81 percent).
Nationwide, physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children.
Effective January 1, 2012, Medicare will require insurers and self-insured companies to report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services (CMS). In the first year of the law’s implementation, claims resolved for less than $5,000 will be exempt from the reporting requirement. In the second year, the threshold for reporting will fall to $2,000 and then $600. In the third year, all claims will have to be reported regardless of payment size. As a first step toward informing the policy debate about the costs of compliance, the amounts likely to be available for recovery under the Medicare Secondary Payer (MSP) Act, and the effects of different thresholds on these quantities, the researchers analyzed the effects of the eventual phaseout of the $5,000 threshold. The results of the analysis suggest that collecting on low-value claims provides Medicare with relatively little revenue and that such claims represent a substantial fraction of the reporting burden.