Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

CMS Approves Medicaid 1115 Waiver in Maryland

March 21, 2019 - CMS has approved Maryland’s section 1115 waiver application for a demonstration to expand access to diabetes care, substance abuse services, and other healthcare services for Medicaid beneficiaries in Maryland.   The agency passed the amendment after evaluating state and federal comments, all of which expressed support for the proposed changes. The approval became effective...


Articles

Prescription Drug Spending Increased Nearly $100B from 2012 to 2016

by

Net prescription drug spending increased from $250.7 billion in 2012 to $341 billion in 2016, according to a new report from the Pew Charitable Trusts. The report also found that over the same period, the share of commercial insurance...

Trump Budget Proposes Medicaid Block Grants, Big Medicare Cuts

by

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...

Payers, Providers, Lawmakers Debate Surprise Billing Guidelines

by

State and federal policymakers are still considering various approaches to solve surprise billing issues and compensate out-of-network providers, including mandated values for reimbursement and independent dispute resolution, according to...

CMS eMedicare Initiative Aims to Modernize Care for Beneficiaries

by

CMS is seeking to modernize the way Medicare beneficiaries access information about their care and coverage with eMedicare, an initiative that uses online tools and mobile applications to improve beneficiary decision-making....

CMS: Healthcare Spending to Rise by 5.5% Annually to $6T in 2027

by

National healthcare expenditures are expected to grow at an average of 5.5 percent annually from 2018 to 2027, reaching $6.0 trillion by 2027, according to a report from the Office of the Actuary at CMS. The report also projects that...

Noncitizens, Lawful Immigrants Much More Likely to Be Uninsured

by

Non-US citizens, including immigrants lawfully present in the country, are significantly more likely than citizens to be uninsured, according to new data from the Kaiser Family Foundation (KFF). The uninsured rate for adult undocumented...

HHS Launches Emergency Services Payment Model for FFS Medicare

by

HHS and the CMS Innovation Center have announced a new payment model for emergency and ambulance services that will enable Medicare fee-for-service beneficiaries to receive quality care with lower out-of-pocket costs. The new payment...

PA Attorney General Intervenes in UPMC, Highmark Health Dispute

by

Pennsylvania Attorney General Josh Shapiro has filed a petition in Commonwealth Court to modify the consent decrees that govern the relationship between UPMC and Highmark Health, two of western Pennsylvania’s largest provider and...

Medicaid Can Increase Hospital Revenue Recovery by $500,000

by

Hospitals could increase their revenue recovery from Medicare bad debt by as much as ten percent per year by identifying insured patients who are also eligible for Medicaid, according to a recent TransUnion Healthcare analysis....

Medicare, Medicaid Best Private Plans for Containing Health Costs

by

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...

PCPs, Psychiatrists Much Less Likely to Accept Medicaid

by

Primary care providers (PCPs) and psychiatrists are among the least likely professionals to accept Medicaid, leaving patients without some of the most fundamental resources for preventing or managing chronic diseases, according to recent...

HHS Proposes Eliminating Drug Rebates to Cut Prescription Costs

by

HHS has announced a proposal that would essentially eliminate the existing drug rebate process and instead encourage direct discounts to patients in an effort to control the costs of prescription drugs. The proposal would exclude drug...

Payers to Focus on Price Transparency, Data Exchange at HIMSS19

by

Price transparency, data exchange strategies, and the challenges of addressing administrative burdens will be among the key discussion topics for payers at this year’s HIMSS Global Conference and Exhibition in Orlando, Florida. Over...

CMS to Expand Tailored Benefits for Medicare Advantage Plans

by

CMS is proposing significant changes to Medicare Advantage geared towards expanding choice and increasing competitiveness in a highly lucrative market. The proposals would increase the number and scope of supplemental benefits available...

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

by

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...

CA Payers Tackle Provider Directories with Data, Collaboration

by

Provider directories are often a patient’s primary source of information when making decisions about their care and coverage. Healthcare consumers use these directories to find out which providers are in their health plan’s...

Walgreens Agrees to $296M Settlement in Healthcare Fraud Cases

by

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...

CMS Tackles Drug Costs with New Medicare Advantage, Part D Models

by

CMS’s Center for Medicare and Medicaid Innovation has launched a new payment model and updated an existing model aimed at helping Medicare Part D and Medicare Advantage plans to lower drug prices and better serve...

Payer Investment May Improve Delaware Primary Care Access

by

Payers can expand primary care access in Delaware by progressively increasing primary care spending until it accounts for 12 percent of all healthcare investment, according to a report from Delaware’s Primary Care...

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...