September 2013
The essential resource for your practice
Volume XXI, Number 9

23 States Expand Medicaid under ACA in 2014

As a result of the Affordable Care Act (ACA), states have the option to expand Medicaid eligibility to their residents less than 65 years of age (therefore not eligible for Medicare) with incomes below 133 percent of the federal poverty line. The changes in eligibility will begin to take place January 1, 2014.

Table of Contents


Coding Corner:

Aetna’s 2013 Data Collection Underway

AUA Comments Urge CMS to Withdraw Proposal to Cap Physician Office Payment

On September 3, 2013 the AUA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Medicare Physician Fee Schedule for calendar year 2014. In the comment letter, a number of concerns were expressed about the proposed policy changes for the coming year. Above all concerns is the AUA’s staunch opposition to CMS’ proposal to cap payment for non-facility services at the hospital outpatient department (OPD) or ambulatory surgical center (ASC) facility rate when the non-facility payment amount exceeds  the facility payment amount for the same service. 

In the comment letter, the AUA urged CMS to withdraw the proposal, because payments for facility and non-facility services are determined under vastly different reimbursement methodologies. Several other flaws were identified with the credibility of the proposal for capitated payment. For example,CMS proposes to compare the 2014 non-facility practice expense relative value units to the 2013 OPD/ASC payment rates. In some cases, this will result in significant disparities between the OPD/ASC cap and the actual rate that would be paid in these settings in 2014. In the proposal, CMS also offers several exclusions. For one of these exclusions, CMS would exempt any service that is performed 5 percent or less in the OPD setting; however, the agency provides no data or discussion about whether an exemption would apply to services rarely performed in the ASC.

For The Record

Mostashari Steps Down as ONC Chief

Farzad Mostashari, MD, has announced that he is stepping down this fall as the head of the Office of National Coordinator for Health Information Technology (ONC). Dr. Mostashari took over the ONCHIT in 2011 after previously serving as its deputy director. see more>>

AUA Continues Work on Liability Reform

Medical liability reform remains an important AUA legislative priority. In 2012, there were roughly 12,000 medical malpractice payouts, averaging nearly $300,000 paid out per claim. Roughly 90 percent of surgeons over age 55 have been the subject of at least one medical malpractice lawsuit. The AUA continues to lobby for reform at the federal level and track developments in state legislatures.

Recent reform proposals have included caps on non-economic damages (pain and suffering), changes in how liability is assigned, and the creation of specific courts to specialize in medical malpractice cases. Many of these laws and proposals vary on a state-by-state basis. About half of all states have a cap on non-economic damages currently in place.