Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Centers for Medicare & Medicaid Services

Sick Members More Likely to Leave Medicare Advantage Plans

July 10, 2017 - A recent study of the Medicare Advantage (MA) landscape shows that sicker members are leaving their plans in greater numbers than their healthy counterparts. The study by the non-partisan Government Accounting Office (GAO) evaluated 126 Medicare Advantage plans above the median rate of disenrollment and found that 35 of them had higher than average disenrollment rates particularly for...


More Articles

4 Ways Payers Can Stay Competitive with Medicare Advantage Plans

by Jesse Migneault

With an aging population and soaring healthcare costs, the public interest in Medicare Advantage (MA) plans has been steadily increasing.   As the marketplace becomes crowded with plan options and insurers, payers must understand how...

CMS Uses Gender, Race For Quality of Care Medicare Study

by Jesse Migneault

The CMS office of Minority Health released a report with data on the quality of care received by Medicare Advantage (MA) enrollees by gender in four ethnic or racial categories.  The data generated by these reports was not used to evaluate...

CMS Issues ACA Health Insurance Exchange Stabilization Rule

by Jesse Migneault

CMS  issued the final version of the 2018 Market Stabilization rule for the Affordable Care Act (ACA) health insurance exchange.   The rule focuses on stabilizing the individual and small group health insurance markets while lowering...

Texas Wrongly Claimed $3.8M in Medicaid Reimbursements

by Thomas Beaton

Texas’s Department of Health and Human Services failed to adhere to federal guidelines and inappropriately claimed $3.8 million in Medicaid managed care reimbursement.    The Office of Inspector General (OIG) recently published...

Doctors Provide 5 Alternative Payment Model Improvements

by Thomas Beaton

A journal article published in the American Journal of Managed Care, outlines recommendations from several doctors on significant ways alternative payment models (APMs) can be improved and better designed. APMs are being promoted throughout the...

CMS Seeking Feedback on Pediatric Alternative Payment Model

by Thomas Beaton

The Centers for Medicare & Medicaid Services (CMS) recently issued a request for information seeking input on designing an alternative payment model focused on improving care quality and cost (APM) that specializes in pediatric care. The...

Bundled Payment Model Attracts More Oncologists than Expected

by Vera Gruessner

The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations participating...

Health Information Technology Allows Payers to Share Data

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) strive to create programs meant to bring “better care, smarter spending, and healthier people.” CMS partnered with healthcare payers across seven regions to improve primary care...

Accountable Care Organizations May Improve Diabetes Management

by Vera Gruessner

Diabetes is a major public health concern for the medical industry with 29.1 million Americans or 9.3 percent of the population diagnosed with the disease in 2012, according to the American Journal of Managed Care (AJMC). In fact, the American...

6.4 Million Enrollees Sign Up on Affordable Care Act Exchanges

by Vera Gruessner

As of December 21, a total of 6.4 million consumers have enrolled in health plans through the Affordable Care Act exchanges on HealthCare.gov, reported the Centers for Medicare & Medicaid Services (CMS) in a fact sheet. The number of enrollees...

CMS Halts on Changing Medicare Part B Prescription Guidelines

by Vera Gruessner

The American Hospital Association (AHA) reported on December 16 that a finalized rule for the prior proposal to test new models for prescription drug payments under Medicare Part B has been scrapped. The Centers for Medicare & Medicaid Services...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) released earlier this week the finalized bundled payment models for cardiac and orthopedic care including the Medicare ACO Track 1+ Model, according to a CMS fact sheet. The bundled payment...

Patients Need More Guidance on Medicare Prescription Drug Plans

by Vera Gruessner

Among Medicare beneficiaries, 34 percent are not taking the time to review their Medicare Advantage prescription drug plan before renewing during the open enrollment period, according to a Walgreens survey. Nearly one in five or 19 percent stated...

CMS Releases Final Rule for Medicare Physician Fee Schedule

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states. The new payment policies...

Vermont’s All-Payer Model Limits Medical Spending Growth

by Vera Gruessner

Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release the...

Did HHS Act Illegally in Transitional Reinsurance Program?

by Vera Gruessner

At the end of September, the Government Accountability Office (GAO) announced in a briefing that the Department of Health & Human Services (HHS) does not have the authority to transfer funds from the collections within the transitional reinsurance...

Children’s Health Insurance Program Enrollment Expands in Flint

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in a press release that it will be awarding $300,000 to the Greater Flint Health Coalition (GFHC) so that more children in Flint, Michigan will be connected to...

CMS Comprehensive Primary Care Program Gained $57M in Savings

by Vera Gruessner

Dr. Patrick Conway, Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), announced in The CMS Blog that 95 percent of all primary care practices participating in the Comprehensive...

CMS Unlawfully Paid $9M to Beneficiaries for Medicare Services

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has improperly paid more than $9 million for Medicare services among 481 unlawfully present beneficiaries during the years 2013 and 2014, according to a report from the Department of Health...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks