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

Medicare and Medicaid Services

How Effective is the Medicaid Drug Rebate Program?

by Stephanie Reardon

Rebate program saved Medicaid an average of $15 billion annually. The Affordable Care Act (ACA) will soon be reducing Medicaid reimbursement. A recent survey was conducted by the Office of Inspector General (OIG) to test the effectiveness...

$10K in Unallowable Excess Plan Costs Claimed for Medicare

by Stephanie Reardon

Due to the incorrect classification of the Excess Plan as a pension plan, CGS claimed unallowable Excess Plan costs. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on...

Medicare’s Expansion Hits Disproportionate Share Hospitals

by Stephanie Reardon

The number of uninsured adults fell by 10.6 million which is good news for disproportionate share hospitals. Over the past year, the number of uninsured adults fell by 10.6 million according to a survey conducted by the Urban Institute...

CMS Rule Limits Payments to Disproportionate Share Hospitals

by Stephanie Reardon

CMS final rule defines ‘uninsured,’ allowing Medicaid patients with exhausted applicable state coverage limits to be covered. Effective December 31, disproportionate share hospitals (DSH) will be subject to the Centers for...

Is it Time to Revamp the CMS Star Rating System?

by Ryan Mcaskill

Healthcare providers are looking to change the CMS star rating to better account for the dual eligible population. The Centers for Medicare and Medicaid Services (CMS) 5-Star quality rating system measures how well Medicare Advantage and...

Top Providers of Medicare Advantage, Drug Coverage Listed

by Ryan Mcaskill

With the Affordable Care Act’s open enrollment just around the corner, more consumer than ever before are looking to get coverage, some for the first time. Industry experts are advising individuals to comparison shop to make sure...

Are Medicare Health Plans Improving or Getting Weaker?

by Elizabeth Snell

With Medicare’s open enrollment period starting tomorrow and running through December 7, the debate is on over the success of Medicare health plans. Critics are upset that the same deficiencies keep happening, while the Centers for...

OIG: Medicare Contractor Erred in Two Reimbursement Claims

by Elizabeth Snell

One Medicare contractor was found by the Office of the Inspector General (OIG) to have made errors in two different aspects of the filing of its Medicare reimbursement claims. First, the National Heritage Insurance Company (NHIC) claimed...

NY Claimed $23M Unallowable Medicaid Reimbursement Funds

by Elizabeth Snell

The New York State Department of Health improperly claimed at least $23 million in Federal Medicaid reimbursement for unallowable supported employment services, according to a recent Office of the Inspector General (OIG) audit. After a...

HHS: Medicare Part B Premiums, Deductibles Staying the Same

by Elizabeth Snell

Healthcare costs are often a top concern for providers and patients. However, one expense is remaining the same for the second year in a row. Next year’s Medicare Part B premiums and deductibles will remain the same as the last...

Audit: Children’s Hospital Had Overpayments Owed to Medicaid

by Elizabeth Snell

A California children’s hospital had credit balances that represented overpayments that had not been returned to the Medicaid program, according to a recent audit by the Office of the Inspector General (OIG). Children’s...

Outpatient Costs Higher for Rural Hospital Medicare Patients

by Ryan Mcaskill

A new report from the inspector general at the Department of Health and Human Services (HHS), found that medicare beneficiaries treated at primary rural “critical access” hospitals (CAHs) pay more for outpatient services than...

Michigan Medicaid Benefits Change Affecting Nursing Homes

by Elizabeth Snell

A Michigan law firm has raised concerns that a change in the way the state’s Medicaid benefits are applied could potentially affect nursing home residents. Michigan is now counting Solely for Benefit Of trusts (SBOs) as assets when...

How Easily Can Seniors Access Medicare Preferred Pharmacies?

by Elizabeth Snell

Regardless of whether older Americans live in small towns or rural areas, the majority of them are still able to find access to preferred pharmacies in Medicare, according to a recent survey. Specifically, 9 in 10 seniors from urban,...

CMS Unveils Medicare Quality Improvement Initiatives

by Elizabeth Snell

The Centers for Medicare and Medicaid Services (CMS) announced two new Medicare quality improvement initiatives yesterday. The agency said that it will expand and strengthen its Five Star Quality Rating System, which is used in nursing...

NH Postpones Medicaid Managed Care Implementation

by Elizabeth Snell

New Hampshire has been working toward its Medicaid managed care implementation, but state officials recently announced that Stage 2 of the initiative has been postponed. Concerns have been raised about the program’s potential impact...

Colo. Agency Claims $4.1M Unallowable Medicaid Payments

by Elizabeth Snell

A Colorado state agency claimed just over $4 million in unallowable Medicaid nursing facility supplemental payments for state fiscal years (FY) 2010 and 2011, according to a recent Office of the Inspector General (OIG)...

CMS Releases 2015 Guidance for Managed Care Rate Setting

by Ryan Mcaskill

The Centers for Medicare & Medicaid Services (CMS) is announcing the availability of the 2015 Managed Care Rate Setting Consultation Guide. It is used by states when developing their Medicaid managed care rate certification packages...

OIG: Texas Agency Not Always in Accordance for Medicaid Payments

by Ryan Mcaskill

Last month, the Office of Inspector General (OIG) released a review of physician supplemental payments that were made to the University of North Texas. It was discovered that the organization received $1,229,407 ($746,461 federal share) in...

OIG: Mass. Agency Used Incorrect Medicaid Claim Adjustments

by Elizabeth Snell

The Massachusetts Executive Office of Health and Human Services, Office of Medicaid overpaid approximately $106 million from October 2008 through December 2010, according to the Office of the Inspector General (OIG). The state agency...

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