Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare

Medicare, Medicaid Best Private Plans for Containing Health Costs

February 12, 2019 - Medicare and Medicaid contain per enrollee health spending growth better than private insurance which likely indicates that recent policies will be key to sustaining this control, revealed a report conducted by the Urban Institute and funded by the Robert Wood Johnson Foundation. Recent estimates show that national health expenditures (NHE) have increased by just 3.9 percent in 2017...


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Single Payer, Public Options Become Focus of Healthcare Debate

by Jennifer Bresnick

As the nation starts to turn its politics-weary eyes towards the 2020 election cycle, a new series of healthcare talking points are emerging, particularly from the left-hand side of the ideological spectrum. Terms like “single...

Medicare “What’s Covered” App Aims for Price Transparency

by Jessica Kent

CMS has launched a new price transparency app that shows users which medical services and tests are covered under Medicare, the agency announced in a recent blog post.   The free “What’s Covered” app provides users...

Walgreens Agrees to $296M Settlement in Healthcare Fraud Cases

by Jessica Kent

Walgreens has agreed to pay a total of $296.2 million in settlements for two separate healthcare fraud cases. The first settlement, approved on January 16, 2019, requires the pharmacy chain to pay $209.2 million to resolve allegations...

86% of Payers Fail to Deliver Readable Medicare Communications

by Jennifer Bresnick

Most documents intended for Medicare and Medicare Advantage members do not meet accessibility standards for the average reader, according to a new report from VisibleThread, a text analysis company. More than 86 percent of payers offering...

Government Shutdown Spares Medicare, Medicaid, But Has Other Impacts

by Jennifer Bresnick

The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers. The nation’s public payers will continue to operate as normal, since funding for CMS is...

Nearly 50% of Pre-Medicare Adults Worried About Healthcare Costs

by Jessica Kent

Forty-five percent of adults aged 50 to 64 are not confident that they will be able to afford healthcare coverage in retirement, according to a poll conducted by the University of Michigan Institute for Healthcare Policy and Innovation and...

CMS Redesigns Medicare Home Health Payment with Case Mix Model

by Thomas Beaton

CMS has proposed a new rule that would recalculate Medicare home health payments using a case mix payment model.   In 2020, the agency plans to implement the Patient-Driven Groupings Model (PDGM) to compensate home health agencies...

Venture-Funded Medicare Advantage Plans Launch into 2019 Market

by Thomas Beaton

Several Medicare Advantage (MA) plans entering the market for the 2019 plan year are backed by millions in venture capital funding and are planning to compete with established payers by promoting new health plan solutions. The recent...

Medicare Advantage Plans Proliferate in 2019, Raising Competition

by Thomas Beaton

Medicare Advantage (MA) payer competition is increasing significantly for plan year 2019 as more than 400 new options hit an already-crowded market, says a new report from the Kaiser Family Foundation (KFF).   More than 2700...

Medicare Diabetes Prevention Program May Have Cost Concerns

by Thomas Beaton

The Medicare Diabetes Prevention Program (MDPP) may not fully cover provider costs needed to administer classes and other programs to prevent diabetes among Medicare members, says a new report from the University of Colorado (UC) School of...

Medicare Deductibles, Premiums to Increase Slightly in 2019

by Thomas Beaton

CMS has announced that Medicare Part A and Part B premiums and deductibles are expected to increase slightly for the 2019 plan year. Part B members will see small increases in both their premiums and their deductibles, while Part A...

Private Insurance Spending Has Outpaced Public Spending Since 2016

by Thomas Beaton

Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

DaVita Medical to Pay $270M for Improper Medicare Advantage Payments

by Thomas Beaton

DaVita Medical Group has agreed to pay $270 million to the Medicare program after identifying suspect billing practices that incorrectly raised its Medicare Advantage payments, says the Department of Justice (DOJ). The improper MA...

OIG Finds Profits to Blame for Denied Medicare Advantage Claims

by Thomas Beaton

Fifty-six percent of Medicare Advantage (MA) payers inappropriately denied claims from beneficiaries and providers to potentially profit from the capitated payment system, according to a report from the Office of Inspector General...

Medicare Advantage Premiums to Decrease by 6% in 2019

by Thomas Beaton

CMS officially announced a six-percent decrease in Medicare Advantage premiums in 2019 as the result of MA enrollment, health plan options, and benefits increase. All signs point to the MA marketplace continuing to be a lucrative...

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

by Thomas Beaton

Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP report.   Twelve million Americans...

Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

by Thomas Beaton

Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial...

MedPAC to Explore if Hospital Consolidation Impacts Medicare Costs

by Thomas Beaton

The House Committee on Energy and Commerce has asked the Medicare Payment Advisory Commission (MedPAC) to investigate whether or not hospital consolidation increases Medicare spending. In a letter to MedPAC, Representatives Greg Walden...

How Payers Can Improve the Value of Long-Term Support Services

by Thomas Beaton

Providing long-term support services (LTSS) impact commercial payers who need to address complications and billions in costs associated with this kind of care. In 2016, the United States spent $92.4 billion on home health care services...

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