Medicare

Should Medicare Accrediting Organizations Also Provide Consulting?

by Jacqueline LaPointe

CMS is questioning if the financial relationships between Medicare accrediting organizations and providers are impacting the accreditors ability to accurately determine if providers are fit to...

Medicare Reimbursement Rules Limit Telehealth Adoption

by Jacqueline LaPointe

Telehealth utilization among Medicare beneficiaries is on the rise, but restrictive Medicare reimbursement rules are stifling the adoption of such services, a new report shows. The CMS report on...

Hospital Readmission Program Penalties Didn’t Raise Mortality Rates

by Jessica Kent

The Hospital Readmission Reduction Program (HRRP) achieved a significant drop in readmission rates for Medicare patients hospitalized for pneumonia, acute myocardial infarction (AMI), and heart failure...

Auditors Recouped $214M in Medicare Improper Payments in 2016

by Jacqueline LaPointe

Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In...

AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments

by Jacqueline LaPointe

CMS should withdraw new proposals to expand site-neutral payments to hospital outpatient clinic visits and services from expanded clinical families delivered at off-campus provider-based departments...

CMS Floats Rule to Save Providers $1.1B, Cut Administrative Burden

by Jacqueline LaPointe

Healthcare providers are slated to save an estimated $1.12 billion annually under a recently proposed rule from CMS that would reduce administrative burdens. The savings would stem from proposals to...

Providers Oppose Collapsing Medicare Reimbursement for E/M Visits

by Jacqueline LaPointe

Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5...

Paying LTCHs Like Skilled Nursing Would Save $4.6B, Analysis Finds

by Jacqueline LaPointe

Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper...

Ascension, Centene Partner to Launch Medicare Advantage Plan

by Jacqueline LaPointe

The nation’s largest non-profit health system, Ascension, and health payer Centene Corporation are teaming up to launch a Medicare Advantage plan in multiple markets, the organizations recently...

Fixing Medicare, Medicaid a Top Priority for New Coalition

by Jacqueline LaPointe

Healthcare industry heavy-hitters are partnering to form a new coalition that generally aims to “improve what’s working in health care and fix what’s not,” especially in...

CMS Extends Home Health Enrollment Suspension to Combat Fraud

by Jacqueline LaPointe

In an effort to reduce Medicare fraud, CMS announced in a new rule that it will extend a moratorium on enrollment of new Medicare home health agencies in Florida, Illinois, Michigan, and Texas. The...

Social Determinants Trend at AHIP’s Medicare, Medicaid Conference

by Jacqueline LaPointe

WASHINGTON DC – Social determinants of health has emerged as a major theme at America's Health Insurance Plans’ (AHIP) National Conferences on Medicare, Medicaid, and dual eligibles in...

Senate Confirms Seema Verma as Next CMS Administrator

by Jacqueline LaPointe

In a 55 to 43 vote yesterday, the Senate confirmed Seema Verma as the next CMS Administrator, according to a New York Times article. Verma, the founder, president, and CEO of a health policy...

Could More Competition Reduce Rising Prescription Drug Costs?

by Vera Gruessner

Prescription drug costs seem to be higher than ever before. Merrill Matthews, Resident Scholar at the Institute for Policy Innovation, wrote about some of the reasons behind these high prices and the...

Does 2015 ICD-10 Transition Mean Millions in Unpaid Claims?

by Jacqueline DiChiara

A hundred physician groups, including the American Medical Association (AMA), expressed strong trepidation regarding the potential for a dangerous accumulation of millions of dollars in unpaid Medicare...

Pinnacle Failed to Properly Refer Medicare Cost Reports

by Ryan Mcaskill

An estimated $1.4 million should have been recouped from healthcare providers and returned to Medicare. According to a recent report from the Department of Health and Human Services’ Office of...

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