Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Medicaid Spending

Medicare, Medicaid Spending Per Enrollee Slower Than Private Plans

February 18, 2019 - Medicare and Medicaid spending saw significantly slower growth per enrollee than private payer expenditures over the last decade, a new report from the Urban Institute shows. The public payers may have experienced the fastest rate of spending growth from 2006 to 2017. But enrollment is largely to blame for the rise in Medicare and Medicaid spending, and spending per enrollee during the...


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Healthcare Spending Growth Slows, Increasing 3.9% in 2017

by Jacqueline LaPointe

Healthcare spending grew at a rate of 3.9 percent in 2017, slowing to rates observed during the 2008 to 2013 period, CMS actuaries recently reported. The analysis from the Office of the Actuary at CMS, published by Health Affairs, showed...

Steady, Moderate Growth for Healthcare Prices and Spending in 2018

by Jacqueline LaPointe

Healthcare prices and spending are seeing steady, but moderate growth, the Altarum Center for Value in Health Care recently reported. Healthcare prices increased just two percent in the second quarter of 2018, bringing healthcare price...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

by Jacqueline LaPointe

In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according to a recent announcement from the...

Medicare Spending, Prices Drive Healthcare Spending Growth

by Jacqueline LaPointe

The healthcare share of the economy should reach 19.7 percent by 2026 as the average annual rate of national healthcare spending growth rate and Medicare spending accelerates, the CMS Office of the Actuary recently projected. The data,...

Service Prices Drove $933.5B Increase in Healthcare Spending

by Jacqueline LaPointe

Service prices and intensity represented over one-half of the $933.5 billion increase in healthcare spending between 1996 and 2013, a new Journal of the American Medical Association study revealed. Prices and intensity were the primary...

Hospitals Saw No Effect on Margins After Medicaid Expansion

by Jacqueline LaPointe

The net impact of Medicaid expansion on non-profit hospital finances was close to zero because uncompensated care cost reductions did not offset Medicaid reimbursement shortfalls, a recent AcademyHealth research revealed. After analyzing...

Pediatric Healthcare Costs 35% Less at Community Health Centers

by Jacqueline LaPointe

Pediatric healthcare costs were $1,133 on average among children primarily using community health centers for care versus $1,750 among children seeing other providers, representing a 35 percent difference, a recent Geiger Gibson/RCHN...

32 Orgs to Cut Healthcare Costs, Use Under CMS Community Demo

by Jacqueline LaPointe

As part of the Accountable Health Communities Model, CMS recently selected 32 organizations to participate in two of the three program tracks that aim to lower healthcare costs and utilization by fostering clinical and community service...

CMS Reveals Medicare-Medicaid Accountable Care Organization

by Jacqueline LaPointe

CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for...

CMS Proposes to Limit Supplemental Medicaid Reimbursement

by Jacqueline LaPointe

CMS recently proposed a rule that would limit a state’s ability to create or increase a Medicaid reimbursement structure for hospitals, physicians, and nursing homes that pays providers for services that are not related to care...

States Could Build Upon the Affordable Care Act to Cut Costs

by Vera Gruessner

The Affordable Care Act has had two main goals for the healthcare system: Increase health insurance coverage for Americans and lower healthcare spending around the country. At this point in time, the Affordable Care Act has brought health...

GAO to CMS: State Medicaid Payment Flaws Hurt Transparency

by Jacqueline DiChiara

The reliability regarding tens of billions of dollars in states’ supplemental payments is being called into question this month by the United States Government Accountability Office (GAO). Because complete reliable data is...

CMS Final Rule Improves Medicaid Beneficiaries’ Care Access

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a final rule – effective on January 4, 2016 – that aims to advance the way covered services are measured and strengthen Medicaid beneficiary protection and...

Medicaid Expansion Bill, HELP Act, Signed by MT Governor

by Jacqueline DiChiara

Medicaid coverage is multiplying for low-income beneficiaries via the Montana HELP Act. Bipartisan legislation (SB405) was recently signed by Montana Governor Steve Bullock, expanding Medicaid coverage to residents between the...

Tennessee Shoots Down Medicaid Expansion

by Ryan Mcaskill

In a 7-4 vote, the Tennessee Senate rejected a plan to expand Medicaid coverage in the state. Last month, it was announced that the state of Indiana became the 28th state (including Washington D.C.) to adopt the Medicaid program under the...

How Too Much Choice is Increasing Nursing Home Costs

by Ryan Mcaskill

A nursing facility building boom in Indiana will cost the state $24 million in additional Medicaid program payments. It is hard to imagine that building more nursing homes in a specific state could have any drawbacks. Unfortunately,...

New York OMIG Saves $2B, Recovers $879M in Medicaid Spending

by Ryan Mcaskill

Last week, New York State’s Office of the Medicaid Inspector General (OMIG) released its 2013 annual report that focuses on spending and fraud prevention. It includes the final totals for Medicaid recoveries and cost savings during...

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