Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare

Medicare Shared Savings Program ACOs Cut Spending by $1 Billion

by Thomas Beaton

Accountable care organizations in the Medicare Shared Savings Program (MSSP) lowered net spending by $1 billion and could help control high expected Medicare spending in the future, a report from the Office of the Inspector General (OIG)...

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 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...

Anthem Blue Cross Engages in Medicare Advantage Risk-Sharing

by Thomas Beaton

Anthem Blue Cross and America's Health Plan (AHP) have announced a risk sharing partnership aimed at improving services for Medicare Advantage beneficiaries in California. AHP and Anthem view the partnership as a gateway for promoting...

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...

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...

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...

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...

Sick Members More Likely to Leave Medicare Advantage Plans

by Jesse Migneault

A recent study of the Medicare Advantage (MA) landscape shows that sicker members are leaving their plans in greater numbers than their healthy counterparts. The study by the non-partisan Government Accounting Office (GAO) evaluated...

Commercial Payer Prices Outpace Medicare, Medicare Advantage

by Jesse Migneault

Commercial payers charge significantly higher prices for common clinical services than Medicare fee-for-service (FFS) and Medicare Advantage plans, according to a new report from the Congressional Budget Office (CBO). Commercial insurers...

Cigna Re-enters Medicare Advantage Market With CMS Approval

by Jesse Migneault

Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned from offering the popular Medicare...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

by Jesse Migneault

Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive...

650 Medical Groups Sign On to Abolish Medicare Budget Panel

by Jesse Migneault

Over 650 medical organizations have signed a letter to Congress from the Healthcare Leadership Council (HLC) supporting the elimination of the Independent Payment Advisory Board (IPAB).  The HLC joins a chorus of support for two...

Humana Expands Orthopedic Bundled Payment Program to NC, VA

by Jesse Migneault

Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee...

Chronic Care Management Fund Aids Underinsured Patients

by Jesse Migneault

The HealthWell Foundation has launched the Movement Disorders Fund to provide financial support for those patients unable to pay insurance premiums or copays for necessary chronic care management. The fund is available to qualifying...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

by Thomas Beaton

The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the...

How CMS Could Boost Operation of Accountable Care Organizations

by Vera Gruessner

Accountable care organizations (ACOs) have become a more mainstream method for improving care coordination and the quality of medical services while providing an opportunity for reducing wasteful spending. For instance, St. John Health...

CMS Ruling Changes Medicare Advantage and Part D Programs

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced in a press release new changes taking place for the Medicare Advantage and Part D Prescription Drug Program starting in 2017. Essentially, these deviations are...

CMS Bundled Payment Model Reduced Hospital Stays to 2.9 Days

by Vera Gruessner

Slowly, healthcare providers are moving their reimbursement toward the bundled payment model across some of their medical services.  The Centers for Medicare & Medicaid Services (CMS)  along with commercial health...

HHS Issues Medicare Coverage Expansion for Diabetes Prevention

by Vera Gruessner

One of the most common chronic medical conditions found today is that of diabetes. Healthcare providers and payers need to work together to find ways that could help reduce the rates of diabetes nationwide. Recently, the Department of...

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