Hospitals Look Forward to New Medicaid Regulations 

Hospital administrations have complied with what they deem inefficient and costly Medicaid regulations for decades with no respite. Recently, CMS, the Centers for Medicaid and Medicare Services, asked hospitals to weigh in on how they can make their services more efficient, and hospital administrators came out with some strong suggestions for how to lighten their burden.

Patients over paperwork

That’s the new CMS initiative, meant to put patients first. CMS is covered with red tape, meant to make the use of its programs efficient and cost-effective, but hospitals feel that to that end, actual treatment is losing out and they’re inundated with paperwork, having to hire employees just to deal with CMS. Patients over paperwork is meant to make the program work better for beneficiaries, decrease the burden on hospitals and make for an altogether more efficient experience. Since the program was started in 2017, there have been many suggestions that CMS has taken into account and begun to implement. 

Some of the changes are simplifying the coding process and decreasing the paperwork necessary for visitation documentation. While administrators say that applaud these changes, there are more urgent changes to make, specifically to help them with cost. A study recently found that hospitals pay upwards of $39 billion just to cover the costs of complying with Medicaid regulations. The amount of paperwork and the exhausting list of regulations necessary to satisfy the framework for payment is becoming too difficult and expensive to manage. Responders to the CMS request for suggestions gave many ideas to make it easier while retaining necessary structure. 

Laborious Medicaid Regulations

One example is that there is a financial incentive for claims reviewers who deny payments, even in error. There is a lengthy and torturous appeals process and hospitals can eventually get what’s due to them. The American Hospital Association (AHA) recommended a financial penalty for over and erroneous denials of claims.

The New Jersey Hospital Association noted that Medicare advantage health plans should have greater oversight and be penalized or rewarded based on quick of delayed payments, which would cut administrative costs for hospitals.

One major sticking point is prior authorization, which means that administrators are filling out tons of paperwork at every turn, never sure if they will be compensated. The American Academy of Ophthalmologists used this language to describe their thoughts about it: “The most burdensome requirement in Medicare.” Hospitals have to ask for authority before every procedure, making the process costly and laborious. The American Association of Neurological Surgeons said “As a result (of prior authorization), patients are now experiencing significant barriers to medically necessary care even for treatments and tests that are eventually easily approved.” the American Association of Health Plans defended the need for prior authorization and said it only counted for 15% of procedures, but admitted that it could be streamlined and lessen paperwork, as well as increase efficiency, for hospitals.

As CMS goes through the suggestions and carries out new initiatives in patients over paperwork, hospitals and facilities all over the US look forward to increased efficiency, which translates into better care for patients.

Leave a Comment