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Guide to Regulation and Legislation

We developed the Regulatory Advisor, an online resource where health care providers can find an overview of current changes in regulations.

Regulatory Advisor Highlights American Taxpayer Relief Act (ATRA) Changes for Health Care Providers

  • 3/13/2013

Regulatory Advisor Highlights American Taxpayer Relief Act (ATRA) Changes for Health Care Providers

On January 2, 2013, President Obama signed the American Taxpayer Relief Act of 2012 (ATRA), and as a result avoided the fiscal cliff that would have resulted in significant tax increases and spending cuts. While the media has focused on avoiding the tax increases and the spending cuts, the new law contains a number of health care provisions that are important to providers in all sub-industries.

ATRA is really a law that creates trade-offs within the reimbursement system, essentially shifting reimbursement from one service to another. For example, one of the primary health care provisions in the law was deferral of the scheduled reductions in physician reimbursement of 27 percent due to the sustainable growth rate formula. In order to defer these, the law reduces reimbursement to hospitals by allowing The Centers for Medicare and Medicaid Services (CMS) to recoup estimated overpayments to hospitals as a result of the transition to Medicare Severity Diagnosis Related Groups (MS-DRGs) from DRGs.

In CMS’s “look-back” analysis, they have estimated an additional $11 billion of overpayment to hospitals, which is over and above the billions they have already recouped over the past three to four years. There are other fairly significant provisions in ATRA, including rebasing allotments to states for Medicaid disproportionate share (DSH) payments, changes in reimbursement for certain radiology and advanced imaging services, as well as the extension of the Medicare Dependent Hospital program and add-on payments for low volume hospitals that was part of the Affordable Care Act (ACA).

The health care industry is in the midst of turbulent times. Regulations are changing fast and becoming increasingly complex. To help health care providers keep pace with these changes, we developed the Regulatory Advisor, an online resource where health care providers can find an overview of current changes in regulations.

Although the information contained in it will always be changing, the Regulatory Advisor is designed to provide a solid summary of the key health care provisions in the emerging regulations and new laws, like ATRA. Our goal is to make the Regulatory Advisor a valuable reference tool for providers in all sub-industries.

At CLA, we recognize access to accurate information is the first step to positioning your organization for future success. The Regulatory Advisor will keep you informed.

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