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Public Payers News

MACRA Implementation Solutions Payers, Providers Should Follow

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MACRA implementation will take place across the healthcare industry starting next year, as more and more providers begin participating in Advanced Alternative Payment Models (APMs) and and the Merit-Based Incentive Payment System (MIPS). Commercial...

ACO Investment Model May Improve Care Delivery in Rural Areas

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While healthcare reform and legislation like the Affordable Care Act have brought medical coverage to an additional 20 million Americans across the country, the patient community still faces some challenges especially in rural areas. When comparing...

Children’s Health Insurance Program Enrollment Expands in Flint

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The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in a press release that it will be awarding $300,000 to the Greater Flint Health Coalition (GFHC) so that more children in Flint, Michigan will be connected to...

CMS Comprehensive Primary Care Program Gained $57M in Savings

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Dr. Patrick Conway, Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), announced in The CMS Blog that 95 percent of all primary care practices participating in the Comprehensive...

New Leadership at Veterans Affairs Results from Transfers

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One public health payer that has had a wide amount of controversy regarding its operations is Veterans Affairs. The latest controversy comes regarding the Veterans Affairs claim that it has new leadership and leadership teams. USA Today conducted...

How Stakeholder Input on Quality Payment Program Differs

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At the end of last week, the Department of Health & Human Services (HHS) released a final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its policies on the new Quality Payment Program. HHS reiterated in a press...

Six Medicaid ACOs Vary in Consumer Engagement Success

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Consumer engagement in a number of Medicaid accountable care organizations (ACOs) tend to vary significantly, according to a September 2016 report from the Center for Consumer Engagement in Health Innovation. With providers being incentivized...

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....

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