The Medicare Advantage cost burden—or the number of individuals for whom healthcare costs absorb 20 percent or more of their income—is lower than the fee-for-service Medicare cost burden...
Payers have the power to influence low-value care spending in a meaningful way.
However, recent data has unveiled the reality that low-value care remains prominent in certain health insurance...
In the first six months of 2020, fee-for-service Medicare utilization dropped across categories of services, races, and dual eligibility statuses, a recent Avalere study confirmed.
Avalere researchers...
Medically underserved areas of the country received higher payments from The Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund. But these funds are likely insufficient for...
As for-profit Medicare Advantage health plans rapidly expand across the nation and pick up a large share of the population’s enrollment, non-profit Medicare Advantage plans will have to adjust...
Medicare Advantage special needs plans (SNPs) may help control healthcare spending for patients with end-stage renal disease (ESRD), a recent study published by Health Affairs found.
CMS established a...
The healthcare industry is moving away from fee-for-service reimbursement. Healthcare professionals recognize that this payment structure is fraught with misuse and overuse, incentivizing providers to...
Update 1/7/2020: This article was updated to reflect that half of the reimbursements in the commercial sector made in 2017 were value-based. Previously, the first line of the article stated that half...
An overwhelming 91 percent of payers think that alternative payment model (APM) activity will increase in the future, according to a recent survey conducted by Health Care Payment Learning and Action...
North Carolina’s transition from a fee-for-service (FFS) model to Medicaid managed care has faced some challenges, but keeping open communication lines with stakeholders enables the state’s...
Update 10/11/2019: This article has been updated to include a statement from the Michigan Association of Health Plans.
Michigan is the latest among state Medicaid programs to back away from...
On Thursday, President Trump issued the Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors that will authorize the Department of Health & Human Services to expand...
American Hospital Association (AHA) is concerned that the recent CMS proposal to relax the 2015 mandatory Medicaid access monitoring review plans will limit providers’ ability to confront...
America’s Health Insurance Plans (AHIP) discouraged CMS from finalizing the risk adjustment data validation (RADV) changes suggested in the agency’s Notice of Proposed Rulemaking (NPRM)...
Documentation issues and other errors led to Medicare fee-for-service programs improperly paying $23.2 billion in 2017, a GAO report revealed.
In comparison, Medicaid fee-for-service programs...
HHS and the CMS Innovation Center have announced a new payment model for emergency and ambulance services that will enable Medicare fee-for-service beneficiaries to receive quality care with lower...
In light of future research on Medicare Advantage spending compared to Medicare fee-for-service, a trio of researchers writing on the Health Affairs blog see the promise in competitive bidding to drive...
The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs...
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...
An audit of MassHealth, the Massachusetts state Medicaid program, found the agency improperly paid approximately $193 million in fee-for-service claims for behavioral healthcare between 2010 and 2015....
