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Public Payers News

CMS Unlawfully Paid $9M to Beneficiaries for Medicare Services

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The Centers for Medicare & Medicaid Services (CMS) has improperly paid more than $9 million for Medicare services among 481 unlawfully present beneficiaries during the years 2013 and 2014, according to a report from the Department of Health...

CMS Medicare Value-Based Care Model Expands to 3 More States

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The states of Alabama, Michigan, and Texas will be able to test the Medicare Advantage Value-Based Insurance Design model beginning on January 1, 2018, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS). During...

Supreme Court Ruling on Medicaid Expansion Led to Coverage Gap

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A Supreme Court ruling in 2012 determined that the Patient Protection and Affordable Care Act is Constitutional while Medicaid expansion is optional for individual states to pursue. This led more than two dozen states to postpone Medicaid...

VT Agency Wrongly Allotted $13M for Health Insurance Marketplace

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The Department of Vermont Health Access went against federal laws when it failed to allocate funds to establishment grants in order to create a public health insurance marketplace, the Office of the Inspector General (OIG) found in a new report....

Medicare Advantage Premiums Drop 13% Due to Affordable Care Act

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The Centers for Medicare & Medicaid Services (CMS) announced in a press release late last week that the average Medicare Advantage monthly premium will be 13 percent lower in 2017 than before the Patient Protection and Affordable Care Act...

Where the Medicare Shared Savings Program May be Lacking

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The latest news from the Medicare Shared Savings Program and its associated accountable care organizations shows that some goals of the project have been gained such as ongoing cost savings and quality performance benchmarks. However, there are...

CMS Reveals 4 Options for Quality Payment Program Participation

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The Centers for Medicare & Medicaid Services (CMS) is working toward assisting healthcare providers in meeting some new regulations that are part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The meaningful use program...

URAC Stresses Accreditation in Medicare Physician Fee Schedule

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This past July, the Centers for Medicare & Medicaid Services (CMS) released revisions to the Medicare Physician Fee Schedule for next year and placed the proposed rule on the Federal Register for display. CMS called on for payers, providers,...

Rising Specialty Drug Prices Plague CMS, Medicare Beneficiaries

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Even though the Obama administration’s Patient Protection and Affordable Care Act assisted Medicare beneficiaries by attempting to end a drug coverage gap called the “doughnut hole” through plan payments and drug manufacturer...

CMS Grants Navigators $63M to Boost Health Insurance Marketplace

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The Centers for Medicare & Medicaid Services (CMS) announced in a press release earlier this week that it will be providing $63 million in grants to both new and older organizations returning to offer health plans through the public health...

Public Health Insurance Marketplace Still Benefits Consumers

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The public health insurance marketplace created through the Affordable Care Act (ACA) may have fewer and fewer health plans participating in the coming years since a number of major insurers have dropped out of the exchanges. This would lead...

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 Integrity...

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 critics....

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 Medicare...

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 the...

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 Protection...

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 different...

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 operated...

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 counties....

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 is...

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