Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

35 Audits Find Medicare Advantage Plans Overbilling CMS

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Audits conducted by the Government Accountability Office (GAO) reveal that up to 35 Medicare Advantage plans fraudulently billed the federal government for medical care provided to many of its elderly patients. The Center for Public...

Patient Wait Times Still High at Veterans Health Administration

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While there have been few major problems within the federal Medicare program that have led to any defamation of the federal agency, Veterans Affairs and, specifically, the Veterans Health Administration often has had its fair share of...

CMS Bundled Payment Models Address Cardiac Care, Hip Surgeries

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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...

OIG: CMS Overpaid Colorado Medicaid Program More than $38M

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The Office of the Inspector General discovered in an audit that the state of Colorado received millions of dollars in unallowable payments from operating the Medicaid Program and the Children's Health Insurance Program. The report from...

Kentucky Governor Proposes Waiver for Medicaid Expansion

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The status of Medicaid expansion has floundered around the nation ever since the Supreme Court ruled that individual states will have the option to choose whether or not to expand their Medicaid programs as called for under the Patient...

CMS Redesigns Value-Based Model for Medicare Advantage Plans

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The Centers for Medicare & Medicaid Services (CMS) has recently announced in a new fact sheet that their Medicare Advantage Value-Based Insurance Design model will be changing slightly during its second year of operation. These...

Affordable Care Act Payment Program Boosts Care, Cuts Costs

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The Patient Protection and Affordable Care Act has a wide variety of reforms that have been implemented to improve care for American citizens. One of these reforms includes a payment model called the Independence at Home Demonstration...

Aetna, UnitedHealth Take On California’s Medicaid Program

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The two major health payers UnitedHealth and Aetna plan to join California’s Medicaid program called Medi-Cal managed care, according to Kaiser Health News. Aetna and UnitedHealth will serve residents of the San Diego and Sacramento...

House Introduces Bill to Delay CMS Hospital Star Ratings

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The Centers for Medicare & Medicaid Services (CMS) hospital star ratings may be postponed due to a new bill introduced on Monday, July 25 by House Representatives Jim Renacci (R-OH) and Kathleen Rice (D-NY). The reasoning for the delay...

Arizona’s Children’s Health Insurance Program Back in Action

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The state of Arizona has had a restriction on accepting funding for the Children’s Health Insurance Program (CHIP) for the last several years. Arizona’s CHIP program was known as KidsCare and offered health coverage for...

Healthcare Spending Growth Hits 5.8% Yearly from 2015-2025

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Healthcare spending may not be rising as quickly as in previous years, but it is still moving upwards. The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released a report last week that states the...

How the MACRA Rule, Baby Boomers Impact Medicare Payment

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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

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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

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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...

Medicare Program Expects Slow Growth in Healthcare Costs

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The federal government is continually striving to reduce healthcare costs while providing better quality care for the patient community. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a news release that the...

CMS Seeks Input to Implement Modular Medicaid IT Solutions

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Last week, the Centers for Medicare & Medicaid Services (CMS) issued a request for information called Modular Solutions for Medicaid IT Enterprise and Pre-certification of Solutions. Essentially, CMS is seeking more information...

CMS Awards $32M for Children’s Health Insurance Program

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While the Affordable Care Act and other healthcare reforms have reduced the numbers of uninsured children around the nation, more work needs to be done and the Centers for Medicare & Medicaid Services (CMS) has invested more funds in...

Why Patients Need More than Reduced Healthcare Spending

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Is lower healthcare spending truly tied to improved quality of care among hospitals? New research published in Health Affairs begs to differ when it comes to rewarding lower quality hospitals that achieved a reduction in healthcare...

Payment Reforms in NY Medicaid Program Face Challenges

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The state of New York has been working toward redesigning their Medicaid program and fixing the various problems plaguing this system. In particular, payment reforms within the New York Medicaid program are being implemented to advance...

4 Steps Toward Reforming the Medicare Program, Lowering Costs

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The Medicare program will need to be reformed in order to account for the rising costs of running this major public health plan.As the baby boomer population gets older and more retired Medicare beneficiaries enter the system, the costs of...

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