Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

CMS

Top 10 Healthcare Spending Categories in the United States

September 20, 2017 - The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based contracting has started to slow the growth curve, but the industry still spends $3.2 trillion on a wide variety of services, according to the latest data from CMS...


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AHIP: Permanently Renew Medicare Advantage Special Needs Plans

by Thomas Beaton

Congress should consider a permanent renewal of the Medicare Advantage Special Needs Plans (SNPs) because of the consumer protections they provide and their market implications, AHIP wrote in a letter to the House of Representatives. A permanent...

Competitive Bidding Curbs Medicare Durable Medical Equipment Costs

by Thomas Beaton

A research team from the Health Care Cost Institute (HCCI) found that the Competitive Bidding Program (CBP) lowered Medicare costs on durable medical equipment (DME), bringing spending down to levels experienced by many commercial payers. The...

Medicaid Reform Requires Outcomes-Based Innovation, Better Data

by Thomas Beaton

Medicaid has steadily provided low-income patients with quality healthcare coverage and could further improve by addressing problematic areas through outcomes-based innovation and data analytics infrastructure, according to commentary published...

CMS: Payers Will Have More Time to File 2018 Health Plan Rates

by Thomas Beaton

Payers still debating how uncertainty over cost-sharing reduction (CSR) subsidies will alter their insurance prices now have more time to submit 2018 health plan rates, CMS announced in a letter to insurers. While the letter says there's...

Payers May Be Neglecting a Growing Medicare Advantage Market

by Thomas Beaton

Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

Low Medicaid Payment Rates Decrease Residential Care Quality

by Thomas Beaton

Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support services (LTSS) according to a new study from...

CMS Approves State Capitated Medicaid Program in Florida

by Thomas Beaton

Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced. The state submitted a request to extend Florida’s Managed Medicaid...

Medicaid Tops Private Insurance in Consumer Satisfaction KPIs

by Thomas Beaton

Medicaid critics have argued that enrollees are not receiving adequate care under the program, but recent consumer surveys indicate that beneficiaries are highly satisfied with their options.   According to a new J.D. Power poll, Medicaid...

Socioeconomic Data Improves Public Health, Payer Programs

by Thomas Beaton

CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

CMS Proposes Medicare Home Health Agency Payment Changes

by Thomas Beaton

CMS proposed Medicare home health agency payment changes in a new rule intended to reduce provider burdens and advance flexible, transparent payment models in the next two years. “CMS is committed to helping patients and their doctors make...

CMS to Host Summit on Behavioral Health Payment, Care Delivery

by Thomas Beaton

CMS has opened registration for a one-day summit where healthcare experts can discuss ideas about innovative behavioral health payment models and related care delivery systems. The Behavioral Health Payment and Care Delivery Summit will take...

DoJ Charges 412 in Medicare Fraud Schemes Totaling $1.3B

by Thomas Beaton

The Department of Justice (DoJ) announced the largest ever healthcare enforcement action in the history of the federal agency took place when the Medicare Fraud Strike Force (MFSF) charged 412 defendants for Medicare fraud losses totaling $1.3...

GAO: CMS Erroneously Paid $16B to Medicare Advantage Orgs

by Thomas Beaton

CMS incorrectly paid $16 billion to Medicare Advantage organizations (MAOs) as a result of insufficient oversight and mismanagement of data, says the Government Accountability Office (GAO) in a new report. Almost 10 percent of all MA payments...

Medicare Hospital Insurance Trust Fund Depleted by 2029

by Thomas Beaton

A statement released by HHS and CMS’s Medicare Board of Trustees (MBT) indicates that the Medicare Hospital Insurance Trust Fund is likely to be depleted by the year 2029. The report suggests that the difference between Medicare income...

AHA to CMS: Continue Funding ACA Cost-Sharing Reductions

by Thomas Beaton

CMS should continue to fund the cost-sharing reductions (CSRs) that keep the Affordable Care Act insurance marketplaces relatively stable, the American Hospital Association (AHA) said in a comment letter. AHA asserts that should the government...

Proposed MA State Budget Targets Medicaid Program Funding

by Thomas Beaton

The Massachusetts House of Ways and Means Committee approved a state budget for fiscal year (FY) 2018 that funds MassHealth, the state’s Medicaid program, through new tax revenues. The committee budget follows the one proposed by Governor...

Medicare Fee-for-Service Program Improperly Paid $41.1B

by Thomas Beaton

Due to problems with oversight and contract issues, the Medicare Fee-for-Service Program wrongly made payments of $41.1 billion in 2016, according to a GAO report. Following an HHS report that initially found the inappropriate payments in the...

CMS: Payers May See 2.95% Rise in Medicare Advantage Revenue

by Thomas Beaton

CMS announced updates to the Medicare Advantage (MA) program and Part D Prescription Drug Program, including an expected 0.45 percent increase in revenues for payers and the potential for up to 2.95 percent in revenue growth. “Medicare...

CHIP Funding Cuts Would Leave 8M Low-Income Kids Uninsured

by Thomas Beaton

More than 8 million low income children living with chronic diseases would lose healthcare coverage and incur higher costs if CHIP funding is not extended beyond 2017, says new research from the Yale School of Medicine. In a study published in...

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