Oncology practices participating in CMS’ Oncology Care Model (OCM) are willing to take on two-sided risk, according to a survey conducted by the Community Oncology Alliance (COA).
The...
More accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) have assumed downside risk as the program progresses, according to a new Avalere analysis.
Most...
The second-largest physician group in the US recently recommended the implementation of a single-payer system or public option to achieve universal coverage.
According to a policy plan released on...
The Medicare Payment Advisory Commission (MedPAC) voted unanimously last week to recommend higher hospital payment rates to Congress later this year.
The group tasked with advising Congress on issuing...
Medicare will save approximately $18 billion from alternative payment models run by CMS’ Innovation Center (CMMI) between 2017 and 2026, a $16 billion difference compared to predictions from the...
Medicare Advantage enrollees had a 2.8 percentage point lower probability of being admitted to a highly rated hospital compared to traditional Medicare enrollees, according to a report from Brown...
Weaknesses in HRSA oversight of the 340B drug pricing program may result in some hospitals receiving discounts when they are not eligible to participate, a new report from The Government Accountability...
Administrative healthcare spending totaled $812 billion in 2017, representing over one-third (34.2 percent) of total expenditures for physician practices, hospitals, long-term care, and private payers,...
The National Association of Accountable Care Organizations (NAACOS) recently announced the formation of the Direct Contracting Taskforce, which offered tools for participation in the latest accountable...
Hospitals are fed up with CMS’ plan to survey 340B hospitals to obtain drug acquisition cost data for drugs covered under the program. In a letter to CMS, 340B Health recently asked CMS to...
Supplemental hospital payments from Medicare were overstated by $502 million for 60 hospitals because of limits on the reconciliation process for outlier payments that stops contracted reviewers from...
Specialists who can surprise bill – emergency medicine and ancillary physicians – had significantly higher provider charges compared to Medicare payment rates versus other specialists, a...
The request for applications (RFA) for Medicare’s Direct Contracting Professional and Global options is now open, according to an announcement on the initiative’s CMS Innovation Center...
More than 600 hospitals have filed a lawsuit against HHS over its decision to continue a 0.7 percent reduction in Medicare reimbursement for inpatient services in federal fiscal years (FFY) 2018 and...
CMS recently announced that the Medicare fee-for-service (FFS) improper rate declined further from fiscal years (FY) 2017 to 2019, reaching the lowest level since FY 2010.
The FY 2019 Medicare FFS...
Medicare fraud not only wastes billions of taxpayer dollars annually, but it also carries a significant human cost, according to a study from researchers at Johns Hopkins Bloomberg School of Public...
Twelve legislative acts, as well as regulatory changes from CMS, are estimated to reduce federal hospital reimbursement by $252.6 billion by 2029, a new report from the health economics consulting firm...
CMS recently issued a proposed rule that aims to significantly reduce provider burden by implementing electronic prior authorization for medications prescribed through Medicare Part D.
Specifically,...
CMS should do away with “incident to” billing for advanced practice registered nurses (APRNs) and physician assistants (PAs) and pursue a stay-based payment design when implementing a...
The Medicare Board of Trustees still projects the Hospital Insurance (HI) Trust Fund, which supports provider payments under Medicare Part A, will deplete by 2026, according to their 2019 annual...
