Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare Reimbursement

Trump Budget Proposes Medicaid Block Grants, Big Medicare Cuts

March 12, 2019 - In its 2020 fiscal year federal budget, The Trump Administration is proposing a significant reconfiguration of the nation’s healthcare landscape by rolling back Medicaid expansion, creating state Medicaid block grants, and drastically cutting funding to Medicare. The budget aims to slash $818 billion in Medicare spending over ten years and trim $1.5 trillion from Medicaid. ...


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Regulatory Changes Needed To Expand Medicare Telehealth Use

by Kyle Murphy, PhD

A new report on Medicare telehealth between 2014 and 2016 shows increased utilization of telehealth services by Medicare beneficiaries but largely remains an untapped resource because of restrictive federal rules and...

CMS Increases Payments for Durable Medical Equipment

by Thomas Beaton

CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices. The rule will raise DME payments to Medicare providers from...

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

by Thomas Beaton

CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare experiences for beneficiaries. The...

DoJ Settles $27.68M in Medicare Fraud, False Claims Act Violations

by Thomas Beaton

The Department of Justice continues its crackdown on Medicare fraud by settling various criminal cases related to $27.68 million of False Claims Act violations. Provider settlements remain the primary medium for healthcare fraud...

Alaska Bill to Alter Emergency Room Payment Rules Brings Concern

by Thomas Beaton

A bill in the Alaska Senate intended to repeal protections around emergency room payments has drawn significant concern from the state’s chapter of the American College of Emergency Physicians (ACEP).  The bill would remove a...

Amerigroup Creates Risk-Based Partnerships for Medicare Advantage

by Thomas Beaton

Amerigroup has announced two risk-based partnerships between health systems in Houston and El Paso that aim to enhance quality of care and increase provider access for Medicare Advantage (MA) beneficiaries. Renaissance Physicians...

Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit

by Jesse Migneault

Insurers Freedom Health and Optimum Healthcare have agreed to pay $32.5 million to avoid further litigation in a whistleblower lawsuit which alleges systemic Medicare Advantage fraud.    The insurers will pay the federal...

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...

AHA Questions CMS Medicare Advantage Risk Score Calculation

by Kyle Murphy, PhD

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...

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...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

by Vera Gruessner

In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that...

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...

CMS Accountable Health Communities Model Stresses Social Needs

by Vera Gruessner

This past January, the Centers for Medicare & Medicaid Services (CMS) announced a new funding opportunity for a program called the Accountable Health Communities (AHC) Model, which focuses solely on the social needs of Medicare and...

Rising Specialty Drug Prices Plague CMS, Medicare Beneficiaries

by Vera Gruessner

Even though the Obama administration’s Patient Protection and Affordable Care Act assisted Medicare beneficiaries by attempting to end a drug coverage gap called the “doughnut hole” through plan payments and drug...

Could Public Option Strengthen ACA Health Insurance Exchanges?

by Vera Gruessner

The ACA health insurance exchanges are facing greater risk now that a number of healthcare payers have decided to drop out of the marketplace. UnitedHealthcare was the first to announce its departure from the ACA health insurance...

CMS Bundled Payment Models Address Cardiac Care, Hip Surgeries

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have recently begun implementing additional alternative payment models centered on episodes of care. CMS has proposed new rules for managing the costs of care and coordination among...

How the MACRA Rule, Baby Boomers Impact Medicare Payment

by Vera Gruessner

Last month, Andrew Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), spoke at the American Medical Association 2016 Annual Meeting about new strategies to pay for Medicare and unlock opportunities for...

Medicare’s Hospital Insurance Trust Fund May Deplete by 2028

by Vera Gruessner

The Medicare program may be in trouble with regard to its financial standing. The latest Medicare Trustees report found that the Hospital Insurance Trust Fund may be depleted in as little as six more years. The longest it is expected to...

17 Health Payers Participating in CMS Oncology Care Model

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is implementing a new payment and healthcare delivery system called the Oncology Care Model. This particular reimbursement program will involve multi-payer arrangements in which...

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