Medicare & Medicaid News

CMS Must Inform Providers on New Medicare Reimbursement Policy

August 26, 2016 - A Vermont judge has ordered CMS to further educate providers and auditors about a recent Medicare reimbursement policy that affects skilled nursing and rehabilitation facilities, reported the Center for Medicare Advocacy. The court stated that CMS failed to properly inform healthcare stakeholders of the maintenance coverage standard that requires...


Articles

CMS: Medicare Accountable Care Organizations Saved Over $466M

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Medicare accountable care organizations (ACOs) saved more than $466 million in 2015, with 125 ACOs qualifying for shared savings payments under the value-based care model, CMS reported in an announcement...

AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+

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The American Medical Group Association (AMGA) has called on CMS to release the claims reimbursement formula for the Comprehensive Primary Care + (CPC+) model, according to a letter sent to the federal...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes

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CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to...

Patients Led to Private Plans to Boost Claims Reimbursement?

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The federal agency is investigating whether some healthcare providers or provider-affiliated organizations are encouraging individuals eligible for Medicare and/or Medicaid to enroll in individual market...

$17B Increase in Medicare Part D Prescription Drug Spending

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Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan

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CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a...

Cardiac Care Bundled Payment Model to Generate Modest Savings

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The recently proposed Medicare bundled payment model for cardiac care will likely bring only modest shared savings or losses to participants, according to a study from Avalere Health. About 85 percent...

Value-Based Care Penalties Spark Greater Quality Improvements

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Financial penalties may be the key to advancing value-based care goals, such as reducing hospital admissions, according to a recent study in the American Journal of Managed Care. Almost two-thirds of...

At-Home Service Value-Based Care Model Saves Medicare $10M

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A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare...

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?

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Many long-term acute care facilities are projected to close over the next few years as Medicare enacts a payment reform rule that will introduce site-neutral payments for certain long-term acute care...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement

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States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States

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To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its...

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts

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Over 120 general acute care hospitals have filed a lawsuit against Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell over Medicare reimbursement reductions under the...

GAO: Medicare Uncompensated Care Aid Not Based on Actual Costs

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Medicare’s uncompensated care payments to hospitals do not account for the actual healthcare costs associated with treating large proportions of Medicaid and uninsured patients, according to a...

CMS Opens Enrollment for Value-Based Primary Care Model

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CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application...

CMS Issues Final Changes for Medicare Reimbursement Programs

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CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its...

CMS Updates Part A Claims Reimbursement, Auditing Policies

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To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will...

How CMS Would Reimburse ACOs for Value-Based Care under MIPS

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With a final rule on implementing MACRA coming in the next couple of months, some accountable care organizations (ACOs) have started to analyze new value-based reimbursement structures under the proposed...

CMS Details Rationale Behind Hospital Quality Ratings

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Just as consumers rate restaurants on Yelp.com on a scale of one to five stars, CMS has published star ratings for healthcare facilities on its Hospital Compare website to boost healthcare...