Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

Minn. Healthcare Payers Reported $687M in Financial Losses

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Local healthcare payers in Minnesota reported financial losses of $687 million due to the rising gaps in premiums and healthcare spending. The Minnesota Council of Health Plans gathered statewide data from insurance companies and HMOs, and found...

CMS: Payers May See 2.95% Rise in Medicare Advantage Revenue

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CMS announced updates to the Medicare Advantage (MA) program and Part D Prescription Drug Program, including an expected 0.45 percent increase in revenues for payers and the potential for up to 2.95 percent in revenue growth. “Medicare...

CHIP Funding Cuts Would Leave 8M Low-Income Kids Uninsured

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More than 8 million low income children living with chronic diseases would lose healthcare coverage and incur higher costs if CHIP funding is not extended beyond 2017, says new research from the Yale School of Medicine. In a study published in...

MA Medicaid Wrongly Paid $193M in Fee-for-Service Claims

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An audit of MassHealth, the Massachusetts state Medicaid program, found the agency improperly paid approximately $193 million in fee-for-service claims for behavioral healthcare between 2010 and 2015.   Questionable payments to the Massachusetts...

WI Improperly Claimed $3M in Medicaid Drug Reimbursement

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Wisconsin’s Department of Health Services failed to correctly invoice providers for over $3 million in Medicaid drug reimbursement, says the Office of the Inspector General (OIG) in a new report, leading to improper reimbursement from federal...

CMS Extends Pediatric Alternative Payment Model Comment Period

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CMS will continue to take public comment on its pediatric alternative payment model (APM) initiatives until April 7, 2017.   In March, CMS issued a request for information (RFI) related to establishing an APM specifically focused on the...

Medicare Limitations on Diabetes Supplies Endanger Patients

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Medicare’s Competitive Bidding Program (CBP) may increase the risk of negative patient safety events or medication nonadherence for diabetics by limiting the variety of available diabetes testing supplies, finds a survey by the American...

Price, Verma Push for Better State Control of Medicaid Programs

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As one of her first actions as CMS Administrator, Seema Verma collaborated with the Department of Health and Human Services (HHS) Secretary Tom Price to detail how the federal government plans to improve its state partnerships to enhance state...

Medicaid Fraud Control Units Recovered $1.8 Billion in 2016

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Data released from the Office of Inspector General (OIG) showcases the investigations, convictions, settlements, and billion-dollar recoveries of Medicaid fraud by Medicaid Fraud Control Units (MFCUs) across the county. MFCUs coordinated over...

Org Offers 25-Point Plan for NJ Medicaid Program Improvement

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The New Jersey Health Care Quality Institute (NJHCQUI) recently partnered with the Nicholson Foundation to release a 25-point plan for modernizing and improving New Jersey’s Medicaid program. “The current program has too often failed...

CMS Seeking Feedback on Pediatric Alternative Payment Model

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The Centers for Medicare & Medicaid Services (CMS) recently issued a request for information seeking input on designing an alternative payment model focused on improving care quality and cost (APM) that specializes in pediatric care. The...

CMS Solicits Payer Participation to Next Phase of CPC+

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In support of second round of payer solicitation for Comprehensive Primary Care Plus (CPC+), The Centers for Medicare & Medicaid Services (CMS) has issued a list of frequently asked questions aimed at increasing payer support for the alternative...

GAO: Erroneous Medicaid Claims Data Pose Fraud Risk at CMS

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Millions of people rely on long-term personal care services under Medicaid coverage, but significant gaps and errors in two major CMS data systems are creating significant opportunities for fraud and abuse.   A new report from the Government...

Bundled Payment Model Attracts More Oncologists than Expected

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The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations participating...

Key Best Practices for Success on the Health Insurance Exchanges

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Which healthcare insurers are succeeding in the health insurance exchanges? What best practices can be taken from these payers? The weekly newsletter Washington Health Policy Week in Review published an editorial answering these questions by...

How CMS Alternative Payment Programs Impact Healthcare

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Over the last five years, the Centers for the Medicare & Medicaid Services (CMS) has released many new payment systems for Medicare providers including shared savings, pay-for-performance programs, and bundled payment models. The alternative...

Health Information Technology Allows Payers to Share Data

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The Centers for Medicare & Medicaid Services (CMS) strive to create programs meant to bring “better care, smarter spending, and healthier people.” CMS partnered with healthcare payers across seven regions to improve primary care...

Why Healthcare Bundled Payment Models May Expand in 2017

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The Centers for Medicare & Medicaid Services (CMS) have advanced bundled payment models by implementing these value-based payment structures in orthopedic and cardiac care. CMS released a finalized bundled payment model for cardiac and orthopedic...

CMS Halts on Changing Medicare Part B Prescription Guidelines

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The American Hospital Association (AHA) reported on December 16 that a finalized rule for the prior proposal to test new models for prescription drug payments under Medicare Part B has been scrapped. The Centers for Medicare & Medicaid Services...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

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The Centers for Medicare & Medicaid Services (CMS) released earlier this week the finalized bundled payment models for cardiac and orthopedic care including the Medicare ACO Track 1+ Model, according to a CMS fact sheet. The bundled payment...

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