Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare Claims

AHA Questions CMS Medicare Advantage Risk Score Calculation

March 6, 2017 - The American Hospital Association (AHA) has voiced concerns about the methodology the Centers for Medicare & Medicaid Services (CMS) intends to use to calculate risk scores for health plans under the Medicare Advantage and Part D prescription drug benefit programs in 2018. Last week, the association issued a written response to the federal agency’s 2018 Advance Notice and Draft Call...

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House Speaker Paul Ryan Proposes a Privatized Medicare System

by Vera Gruessner

House Speaker Paul Ryan announced in an interview with Fox News Channel several days after the presidential election that the Republican-controlled Congress and White House will look to create a privatized Medicare system and cut funding from...

Medicare Advantage Premiums Drop 13% Due to Affordable Care Act

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced in a press release late last week that the average Medicare Advantage monthly premium will be 13 percent lower in 2017 than before the Patient Protection and Affordable Care Act...

Medicare Program Expects Slow Growth in Healthcare Costs

by Vera Gruessner

The federal government is continually striving to reduce healthcare costs while providing better quality care for the patient community. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a news release that the agency...

4 Steps Toward Reforming the Medicare Program, Lowering Costs

by Vera Gruessner

The Medicare program will need to be reformed in order to account for the rising costs of running this major public health plan.As the baby boomer population gets older and more retired Medicare beneficiaries enter the system, the costs of operating...

How the SMART Act Resolved Medicare Secondary Payer Issues

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has released its final rule detailing a timeline for the expansion of the Medicare Secondary Payer Web portal, which must meet the requirements of the Medicare IVIG Access and Strengthening...

Are Skilled Nursing Facilities Fraudulently Billing Medicare?

by Vera Gruessner

Skilled nursing facilities are an essential part of improving the health among the elderly and the disabled. However, some skilled nursing facilities and rehabilitation centers have taken advantage of Medicare beneficiaries by fraudulently billing...

End-of-Life Counseling Sessions Stall despite Medicare Payment

by Vera Gruessner

Starting in January 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing physicians for conducting end-of-life and advanced care planning discussions with patients who are Medicare beneficiaries. Doctors are able to...

CMS Releases Medicare Data for Quality-Based Metrics

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is further attempting to innovate and improve medicine through quality-based metrics, as the CMS Office of Minority Health has released new data that provides more information on the quality...


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