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Medicare Advantage Plans Decrease Avoidable Hospitalizations

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The Centers for Medicare & Medicaid Services (CMS) may be able to reduce healthcare spending by decreasing the number of hospitalizations, emergency room visits, and other expensive medical care services.  This could be done by bringing...

Medicare Part B Drug Prescribing Model Benefits Beneficiaries

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There has been a fair amount of controversy regarding Medicare Part B drug prescribing reforms. For instance, the Community Oncology Alliance (COA) has called for blocking the regulation changing Medicare Part B drug prescribing practices. The...

NY’s Medicaid Payment Reforms Aim to Reduce Hospital Use

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The state of New York is undergoing significant payment reforms within its Medicaid program. In 2014, Governor Andrew Cuomo finalized negotiations with federal agencies to create a waiver that would allow New York to renew $8 million in federal...

How the SMART Act Resolved Medicare Secondary Payer Issues

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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...

Audits against Medicare Advantage Organizations Found Subpar

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In order to ensure government funding isn’t used to pay erroneous or fraudulent medical claims, the Centers for Medicare & Medicaid Services (CMS) conducts risk adjustment data validation (RADV) audits among Medicare Advantage organizations....

Are Skilled Nursing Facilities Fraudulently Billing Medicare?

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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...

Do Medicare Part B Prescription Drug Changes Hurt Rural Hospitals?

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The proposed changes to the Medicare Part B prescription drug program is finding opposition among multiple medical organizations. The Centers for Medicare & Medicaid Services (CMS) will need to address the problems in the new proposed rule...

Is the Medicare Part B Proposed Rule ‘Bad Medicine’?

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Two months ago, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed rule that would create new payment models meant to reimburse providers for assigning prescription drugs. This would change the payment structure of...

Did the Affordable Care Act Lower Medicare Spending?

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The Affordable Care Act and other regulatory changes were meant to reform the healthcare industry and save costs on wasteful spending. Recent results coming from the Department of Health and Human Services (HHS) show that the Affordable Care...

End-of-Life Counseling Sessions Stall despite Medicare Payment

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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...

How the ACA Increased Enrollment in Medicaid and CHIP Programs

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Last Friday, the Centers for Medicare & Medicaid Services (CMS) released a report covering the state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data for the month of February. This type of information...

MACRA Rule Revolutionizes the US Healthcare Payment System

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Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rulemaking regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation has made a significant difference to the...

New Proposed MACRA Rule Renovates Information Technology Use

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The Department of Health & Human Services (HHS) has proposed new rules regarding the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) which will essentially remove the meaningful use program and move forward in advancing health information...

How CMCS Improved Managed Care in State Medicaid Programs

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Earlier this week, the Centers for Medicaid and CHIP Services (CMCS) finalized its ruling on the managed care Medicaid reimbursement regulations. Soon afterward, the National Association of Medicaid Directors (NAMD) released a statement regarding...

CMS Rule Renovates Coverage beyond ACA’s Medicaid Expansion

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The Medicaid program has greatly changed since the passage of the Obama administration’s Affordable Care Act. Most importantly, more than half of the states throughout the nation have implemented Medicaid expansion, which means that more...

SNF Medicare Reimbursement Expected to Rise by $800 Million

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Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that changes the Medicare reimbursement policies at skilled nursing facilities for 2017. Essentially, the proposed rule further brings Medicare payments...

CMS Releases Medicare Data for Quality-Based Metrics

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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...

Primary Care Payment Reform Targeted in Multi-Payer Initiative

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The Centers for Medicare & Medicaid Services (CMS) are renovating how primary care is delivered throughout the United States. According to a news release from the agency, CMS is launching a program called the Comprehensive Primary Care Plus...

Arizona Declines Funding Children’s Health Insurance Program

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Nearly 20 years ago, the Children’s Health Insurance Program (CHIP) was established in order to ensure the offspring of low-income families who didn’t qualify for the Medicaid insurance plan did have the right to healthcare coverage....

CMS Ruling Changes Medicare Advantage and Part D Programs

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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 meant...

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