Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

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...

Top Ways Payers Integrate Patient Engagement Strategies

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The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate patient engagement and bring the patients...

CMS Accountable Care Organization Model Targets Dual Eligibles

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On December 15, the Department of Health & Human Services (HHS) announced the creation of the new Medicare-Medicaid Accountable Care Organization (ACO) Model. The model is meant to improve the quality of care and decrease costs of beneficiaries...

Tom Price and His Stance on Value-Based Care Reimbursement

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Representative Tom Price, an orthopedic surgeon, was nominated to be the next Secretary of the Department of Health & Human Services (HHS) on November 29. What does this nomination mean for value-based care reimbursement in the Medicare program?...

CMS Commits to Improved Care Quality, Medical Spending Cuts

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The Centers for Medicare & Medicaid Services (CMS) will continue to work toward creating a better healthcare system for patients while keeping close track of medical spending regardless of which political party is in charge, said Andy...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

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The Centers for Medicare & Medicaid Services (CMS) has reduced the Medicare fee-for-service improper payment rate from last year’s 12.1 percent to 11 percent in 2016, The CMS Blog reports. CMS has dedicated itself in recent years to...

Patients Need More Guidance on Medicare Prescription Drug Plans

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Among Medicare beneficiaries, 34 percent are not taking the time to review their Medicare Advantage prescription drug plan before renewing during the open enrollment period, according to a Walgreens survey. Nearly one in five or 19 percent stated...

CMS Releases Final Rule for Medicare Physician Fee Schedule

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Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states. The new payment policies...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

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In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that Medicare...

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