Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

Commercial, Public Payer Healthcare Fraud Cases Total $21.6M

May 18, 2018 - The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims submissions. Public payer programs are frequently targeted by criminals and have a high risk of provider fraud. Federal agencies recovered nearly $2.4 billion in 2017 through civil and criminal recoveries...


Articles

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

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Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including some...

More Competition May Benefit Medicare Advantage Bidding Process

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The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings Institute report. Brookings analysts believe...

Managing Payer Challenges in the ACA Risk Adjustment Program

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The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces.   Under the ACA, payers can only adjust...

CMS Increases Payments for Durable Medical Equipment

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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 June...

CMS Approves Medicaid Work Requirements in New Hampshire

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CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility.  The approval makes New Hampshire the fourth state to integrate...

Verma: Patient Care, Payment Design Need Value-Based Reforms

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Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the American Hospital Association (AHA). During the...

Former CMS Employee Found Guilty in Insider Trading Scheme

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A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty verdict in the Southern District of New York...

Uninsured Rate among Working Adults Rises to 15.5% in 2018

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The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey. In 2016, 12.2 percent of working adults lacked health insurance.  During...

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

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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 proposed...

CMS Releases Medicare Advantage Encounter Data to the Public

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CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program. The agency will allow researchers to access 2015...

Short-Term Health Plans Lack Mental Health, Prescription Benefits

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Short-term health plans generally lack mental health and prescription drug benefits and may create financial-based health insurance barriers for unhealthy beneficiary populations, according to a Kaiser Family Foundation (KFF) analysis. The KFF...

CMS Aims to Catalyze Advancements in Consumer Price Transparency

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A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS Administrator Seema Verma. Verma explained...

CMS Rule Ups Medicare Hospital Payments, Cuts Quality Measures

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CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would also increase price transparency and provider...

AHIP Calls for Changes in Proposed Association Health Plan Policy

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AHIP has issued a statement to CMS that calls for changes in the agency’s proposed rule on association health plan (AHP) and short-term plan policy to avoid unintentional disparities in health insurance access for individuals with pre-existing...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

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CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management, and...

Senate Bill Proposes Medicare Health Plan for All Ages

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Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges, as well as the employer-sponsored market....

HHS Appoints James Parker to Address Health Insurance Costs

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HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served as...

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

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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 recoveries, according...

How Payers Can Succeed in Association Health Plan Markets

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Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize based...

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