EDITOR’S NOTE: Contributing to this article was Rhonda Buckholtz, a member of the HIMSS professional development committee.
Two text versions of the Senate bill to repeal and replace the Patient Protection and Affordable Care Act (ACA) are expected to be revealed today with the Congressional Budget Office (CBO) scheduled to conduct an analysis on Monday.
Senate Majority Leader Mitch McConnell (R-Ky.) anticipates that there will be a vote next week on the Better Care Reconciliation Act (BRCA). Under reconciliation, the BRCA needs 50 votes to start debate on the Senate bill.
In the meantime, some media outlets are saying up to 10 Republican senators might cast a no vote. Next week there could be a procedural vote to advance the bill to the floor of the Senate and begin consideration of the legislation. The Senate is racing against the clock with the August recess pending.
This week, however, House and Senate lawmakers returned from the Fourth of July recess, with many leaving behind the wrath of constituents speaking out on concerns about the BRCA. On Monday, there was television news coverage of protestors who were on Capitol Hill camping out in front of certain senators’ offices.
There are television commercials airing as well from a group called “Save our Care” in states where the senators may be on the bubble for voting for the BRCA. The CBO did score the bill a few weeks back and found 22 million more uninsured over time, mostly low- and moderate-income residents with a budget deficit reduction of $321 billion (versus $202 billion for the House bill, the American Health Care Act [AHCA]).
While premiums would be reduced in the individual market in the long run, coverage would have high deductibles and in waiver states contain fewer benefits. There would be a five-year ramp down of current Medicaid benefits, and the federal match would, by 2023, go down to 75 percent There are other Medicaid changes, too. While essential health benefits remain the same as under the ACA, states can ask the Centers for Medicare & Medicaid Services (CMS) for Section1332 State Innovation Waivers.
Pre-existing conditions remain the same as the ACA. There is some premium assistance in the BRCA and other things in the bill include repeal of individual and employer mandate. Most of the taxes that were generated through ACA would be repealed, including the medical device tax, prescription tax and even the tanning tax. In addition, the prevention and public health fund would be cut from appropriations after 2018.
A number of groups, such as American Association of Retired Persons (AARP) and the American Medical Association (AMA), strongly oppose the bill due to concerns with patient access to needed care.
The challenge for Senator McConnell is to balance the competing interests within the Republican Senate. For example, there is Senator Ted Cruz (R-Texas), who tends to be more conservative. The summary of his Consumer Freedom Option says, “If an insurer sells at least one Obamacare-compliant plan on a state’s exchange, that insurer would be permitted to sell any other plan that consumers want.” No legislative language has been circulated yet for this amendment.
More moderate Republicans, such as Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), are concerned about the Medicaid provisions in the proposed legislation. There is also President Donald Trump’s tweet that there should just be repeal (and not repeal and replace) for now.
Of course, then there are the Democrats, who don’t want to help the other party repeal President Obama’s signature healthcare legislation.
Prior to last week’s recess there were also concerns on the part of a number of senators on the lack of transparency in how the BRCA bill was drafted by a relatively small group of senators.
So, stay tuned.
Imagine receiving notice that your healthcare organization faces a potential multimillion-dollar repayment demand based on the review of just 100 claims. This scenario, playing out
Some of you may have read my article from last week kindly published as a special bulletin. For those who did not, let me recap.
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
