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Supreme Court upholds reform
In its decision, the U.S. Supreme Court said the individual mandate is within Congress' constitutional authority to levy taxes. The high court also ruled that the federal government couldn't withhold all Medicaid funds to states that opt out of expanding coverage. <a target='_blank' href='http://www.fiercehealthcare.com/story/supreme-court-upholds-healthcare-reform/2012-06-28'>Read more</a> -
CMS begins 5010 enforcement; HIPAA mega rule expected
The Centers for Medicare & Medicaid Services starts enforcing regulations <a target='_blank' href='http://tinyurl.com/9nq53v4'>requiring the use of the 5010 standards</a> in all electronic healthcare transactions. The agency delayed enforcement twice, after much of the industry still was not ready to make the transition.
<p>Healthcare entities also can expect the <a target='_blank' href='http://tinyurl.com/6mb2two'>final omnibus HIPAA rule</a> to be out by the end of the summer. -
Insurers pay consumers $1B in rebates
Thanks to the medical-loss ratio requirement, health insurance companies <a target='_blank' href='http://www.fiercehealthpayer.com/story/insurers-owe-consumers-more-1b/2012-06-24' >pay their consumers more than $1 billion dollars</a> in rebates for 2012. Almost 13 million Americans in both individual and group plans receive rebates, with the average household receiving $151. -
Value-based purchasing kicks in
The Centers for Medicare & Medicaid Services begins <a target='_blank' href='http://tinyurl.com/8kbz56y'>levying payment penalties on hospitals</a> with high readmissions rates under health reform's Hospital Readmission Reduction Program. And thanks to the Value-Based Purchasing Program, Medicare reimbursements to hospitals will be based on performance measures, with patient satisfaction determining 30 percent of the incentive payments and improved clinical outcomes deciding 70 percent. -
Hospitals see 0.09% payment bump
With the <a target='_blank' href='http://www.fiercehealthcare.com/story/providers-have-mixed-feelings-cms-proposed-hospital-payments/2012-04-27'>proposed Inpatient Prospective Payment System rule</a>, the Centers for Medicare & Medicaid Services will increase payment rates to general acute care hospitals by 0.9 percent in fiscal year 2013 and 1.9 percent for long-term care (LTC) hospitals, among other changes. -
Providers must attest to MU Stage 2
According to the 672-page <a target='_blank' href='http://www.fierceemr.com/story/cms-unveils-final-rule-stage-2-meaningful-use/2012-08-23' >final rule</a>, providers must meet the requirements for Stage 2 of the Meaningful Use program for electronic health records starting in 2014 to qualify for incentive payments. Stage 2 includes 20 measures for eligible professionals and 19 for eligible hospitals and critical access hospitals. -
Insurance exchanges take effect
Consumers in every state will have <a target='_blank' href='http://www.fiercehealthpayer.com/story/health-insurance-exchange-final-rule-insurers-must-justify-rates/2012-03-14'>access to coverage through health insurance exchanges</a>. The policies could have started accepting applications as early as Oct. 1, 2013. If a state has decided not to implement an exchange, the U.S. Department of Health & Human Services will run a federally facilitated exchange for its residents. -
New rules governing electronic fund transfer
Starting in 2014, doctors, hospitals and health plans have new rules to follow for <a target='_blank' href='http://www.fiercehealthit.com/story/hhs-rules-governing-electronic-fund-transfer-could-save-hospitals-9b/2012-08-08 '>electronic fund transfer (EFT) and remittance advice transactions</a>. By eliminating administrative obstacles to electronic claim payments, the U.S. Department of Health & Human Services said the new rules will save up to $9 billion over 10 years. -
Switch from ICD-9 to ICD-10
As of Oct. 1, 2014, healthcare organizations must convert to the ICD-10 coding system. Under the <a target='_blank' href='http://www.fiercehealthit.com/story/icd-10-gets-one-year-delay-cms/2012-08-24' >final rule</a>, all health insurers must use a unique health plan identifier (HPID). -
Meaningful Use Stage 3 begins
Two years after reaching Stage 2, providers should be meeting Stage 3 requirements of the Meaningful Use incentive program beginning 2016. <a target='_blank' href='http://www.fierceemr.com/story/meaningful-use-stage-3-may-require-multi-factor-authentication/2012-09-11'>The recommendations may include multifactor authentication</a> in certain cases involving remote access to patient-protected health information.
