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Public Payers News

CMS Ruling Changes Medicare Advantage and Part D Programs

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Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced in a press release new changes taking place for the Medicare Advantage and Part D Prescription Drug Program starting in 2017. Essentially, these deviations are meant...

How Medicaid Expansion Improves Behavioral Healthcare Access

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When the Patient Protection and Affordable Care Act was passed into law, it established that Medicaid expansion across all 50 states would take place. However, a Supreme Court ruling created a clause that allowed Medicaid expansion to be optional...

Medicaid Challenges with Value-Based Care Payment Models

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With the federal government and the healthcare industry as a whole focusing their efforts on adopting value-based care payment models that revolutionize medical care, it should come as no surprise that the National Association of Medicaid Directors...

HHS Issues Medicare Coverage Expansion for Diabetes Prevention

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One of the most common chronic medical conditions found today is that of diabetes. Healthcare providers and payers need to work together to find ways that could help reduce the rates of diabetes nationwide. Recently, the Department of Health...

Will Changes in Medicare Part B Drug Prescribing Cut Costs?

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The Centers for Medicare & Medicaid Services announced last week that new healthcare payment models would be utilized in Medicare Part B drug prescribing practices. These innovative reimbursement strategies are expected to bring down the...

4 Health Payer Industry News Items Revealed at HIMSS16

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With the 2016 HIMSS Conference and Exhibition closing its doors, it grows important to address how the health payer industry remains vital to both the ongoing technology advancements in medicine and patient care in general. Below we outline some...

4 Elements Necessary for Switching to ICD-10 Diagnosis Coding

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On October 1, 2015, the healthcare industry from payers and federal agencies to hospitals, physicians, and specialists transitioned to ICD-10 diagnosis coding. Many healthcare providers were concerned that their practices would not be prepared...

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies

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Healthcare access among Medicare and Medicaid beneficiaries remains a top priority for the Centers for Medicare & Medicaid Services (CMS). In 2015, CMS listened to the concerns of many beneficiaries and discovered that many do not have efficient...

Merit-Based Incentive Payment System Transforms Meaningful Use

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Last Spring, the Senate and the House of Representatives passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and repealed the former flawed SGR formula. Over the coming years, this law will require healthcare providers to...

Star Ratings System Created for Medicaid Home Health Services

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Earlier this week, the Centers for Medicare & Medicaid Services (CMS) established a final rule that alters the Medicaid home health services definition to include additional requirements for home care services which expands beyond medical...

Medicare Spending May Increase $500 Billion over Next Decade

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The Congressional Budget Office (CBO) has released information showing growing deficits that are expected to increase by more than $100 billion in 2016 and expand to $1 trillion by 2022. The Committee for a Responsible Federal Budget released...

Medicare-Medicaid Financial Alignment Shows Cost Savings

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One program led by the Centers for Medicare & Medicaid Services (CMS) called the Medicare-Medicaid Financial Alignment Initiative moves toward improving the coordination and quality of healthcare services within Medicaid health homes while...

Medicaid Managed Care Spending Rose to $107 Billion in 2014

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One area in which the federal government has put in excessive amounts of funds is the managed care arena. The reasoning may be due to the growing elderly population of baby boomers. The US Government Accountability Office released a report showing...

CMS, AMA Delve into Past and Future of Healthcare Market

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Yesterday, representatives from the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association came together to provide an overview of the current healthcare market in a presentation called “A Discussion with...

HHS Announces $157M for Accountable Health Communities Model

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Earlier this week, the Department of Health and Human Services (HHS) announced new funds available of as much as $157 million to develop an Accountable Health Communities Model, which will show whether testing beneficiaries on social needs and...

Why State Medicaid Expansion May be Worthwhile for All

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When the Supreme Court ruled that Medicaid expansion under the Patient Protection and Affordable Care Act is voluntary among the states, this set a precedence that allowed individual states to play partisan politics and withhold from financing...

The Impact of Medicare Advantage Plans, ACOs, Payment Reform

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Now that the New Year is upon us, the Medicare program may be undergoing some significant changes that could affect patients and healthcare services. One ongoing transformative characteristic is the rise in enrollment in Medicare Advantage plans....

Medicaid Expansion Brought More Cancer Screenings among Women

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Several years ago, the Supreme Court ruled that state Medicaid expansion under the Patient Protection and Affordable Care Act is to be optional for each region. This led a large number of states to forego expanding their Medicaid program for...

The History and Evolution of CHIP and the Medicare Program

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When the medical industry including diagnostics and treatment became more complex and sophisticated in the early 1900s, everyday citizens began to see a surge in the costs for healthcare services. With more complicated procedures, treatment for...

Drug Spending Dashboard Shows Lack of CMS Negotiating Power

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced the release of an online dashboard that reports the amount of funds Medicare spends on prescription drugs. The drug spending dashboard covers both Part B and Part D programs,...

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