IHA Daily Briefing: May 15

Tuesday, May 15, 2018

IHA, ISMS Push for Key Workers' Comp Legislation
U.S. Senate Holds 340B Hearing
IHA Memo on Modifier 90 for Reference Labs
IHA Quality Awards: Entry Period Now Open
Briefly Noted

IHA, ISMS Push for Key Workers’ Comp Legislation
IHA and the Illinois State Medical Society (ISMS) are working together to urge the General Assembly to approve House Amendment 1 to Senate Bill (SB) 904, legislation aimed at ensuring access to quality healthcare for injured workers and addressing a growing crisis of unpaid Workers’ Compensation medical bills.

Healthcare providers throughout Illinois have documented a substantial increase in the delay of payment for “pre-authorized” workers’ compensation medical care. While insurers are authorizing the medical care, they are delaying payment until the claim at the Workers’ Compensation Commission is resolved, which can take as long as three years. Recently, an Illinois appellate court ruled that a healthcare provider is not entitled to recover interest from employers when they do not pay worker compensation medical bills on time.

House Amendment 1 to SB 904 would make three changes to the Illinois Workers’ Compensation Act:

  • Allow medical professionals to collect interest on late medical claims by filing a claim for this interest in circuit court, and increase that late payment penalty from 1 to 2 percent. While this interest provision has been in law since 2005, medical providers have had no means to collect this interest on their behalf;
  • Require workers’ compensation insurance companies to send an Explanation of Benefits to medical providers explaining why they have denied the authorization of medical care or what additional information they need to make a decision on that care; and
  • Prevent workers’ compensation insurers from ignoring the law requiring them to use electronic billing for workers’ compensation claims. This has been the law for seven years, yet workers’ compensation insurers still refuse to use standardized electronic billing systems that are used throughout the healthcare world.

For more information, see an IHA/ISMS fact sheet.


U.S. Senate Holds 340B Hearing  
Today, the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee held its second in a series of hearings on the 340B Drug Pricing Program. Representatives from the U.S. Dept. of Health and Human Services (HHS) Office of the Inspector General (OIG) and U.S. Government Accountability Office (GAO) testified on the recommendations their respective offices have on how to better manage and conduct oversight on the program. Dr. Debra Draper with the GAO spoke about the need for Congress to more clearly define the intent of the program to help provide transparency in the program. Ann Maxwell of the HHS OIG recommended that the best way to ensure transparency in the program is to have the Health Resources and Services Administration (HRSA) share drug prices with both providers and states to ensure that drug companies are not overcharging for 340B drugs.

Sen. Bill Cassidy (R-LA), who has long expressed concerns over the lack of transparency in the 340B drug program, cited a study that if hospital eligibility for the program is tied to providing at least one percent of revenue in charity care, then nine percent of current 340B hospitals would no longer be eligible. A proposal to tie eligibility to the level of charity care provided by a hospital is among President Trump’s 2019 budget requests.

HELP Chairman Lamar Alexander (R-TN) mentioned the next hearing will include testimony from HRSA, which administers the 340B Drug Pricing program.


IHA Memo on Modifier 90 for Reference Labs
In February, the Illinois Dept. of Healthcare and Family Services (HFS) announced a new requirement for hospitals billing fee-for-service on the HFS 2360/837P claim to identify outpatient lab services performed at a reference laboratory by reporting Modifier 90 in conjunction with the appropriate procedure code, effective for dates of service on and after March 1. This instruction generated a number of questions from member hospitals on implementation of the Modifier 90 requirement, which IHA’s Patient Financial Services staff subsequently worked with HFS’ Non-Institutional Providers Unit to address.

On May 7, HFS issued a provider notice that clarifies a new requirement for hospitals to report Modifier 90 on certain outpatient claims for reference laboratory services, describes application of the policy to Medicaid Managed Care Organization and Medicare crossover claims and announces a new implementation date of June 1.

Today, IHA issued a memo detailing the clarifying information on Modifier 90 in HFS’ provider notice.


IHA Quality Awards: Entry Period Now Open
Pick your organization's best quality improvement initiatives and get them ready for submission to IHA's annual Quality Excellence Achievement Awards. The entry period opened Tuesday and will close on June 15.

Hospitals or health systems may submit a maximum of one project per category for a total of six submissions:

  • Behavioral Health;
  • Care Coordination;
  • Infection Prevention;
  • Patient Safety;
  • Population Health; and
  • Workplace Safety.

Palliative care projects should be submitted under Care Coordination.

The Quality Awards are open to all IHA members, as well as non-members engaged in collaborative work with an IHA member. A national panel of judges will score each submission based on:

  • Project statement and project goals (25 points);
  • Team composition (20 points);
  • Improvement planning and implementation (45 points);
  • Results and impact (60 points);
  • Sustainability (20 points); and
  • Scope and spread (15 points).

Up to an additional 15 points can be earned if projects show that their impact extends to the community, regional or state level. Award recipients will be notified in August and will receive their plaque at the 2018 IHA Leadership Summit on Sept. 26. IHA will produce a video showcasing the efforts of each award recipient.

Submit your organization's quality improvement work.


Briefly Noted
The Illinois Dept. of Healthcare and Family Services (HFS) announced a due date extension for the May hospital provider assessment. The revised payment date is May 25. HFS encourages providers to subscribe to its email list to be notified of future assessment extension or revised due dates. Questions may be directed to the department’s Provider Assessment Unit at 217-524-7110.