Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

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 children of...

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 growth...

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 greater...

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 last...

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 healthcare...

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 agency...

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 regarding...

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 ensuring...

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 spending....

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 medical...

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 operating...

CMS Healthcare Payment Strategies Cut Hospital Readmissions

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The Centers for Medicare & Medicaid Services (CMS) Innovation Center was created in order to develop more revolutionary healthcare payment strategies that could reduce the cost of Medicare, Medicaid, and the CHIP programs. One of its initiatives,...

Coordination, Interoperability Key for MACRA Requirements

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Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will essentially drop meaningful use requirements in favor of the Merit-based...

Medicare Advantage Plans Decrease Avoidable Hospitalizations

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The Centers for Medicare & Medicaid Services (CMS) may be able to reduce healthcare spending by decreasing the number of hospitalizations, emergency room visits, and other expensive medical care services.  This could be done by bringing...

Medicare Part B Drug Prescribing Model Benefits Beneficiaries

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There has been a fair amount of controversy regarding Medicare Part B drug prescribing reforms. For instance, the Community Oncology Alliance (COA) has called for blocking the regulation changing Medicare Part B drug prescribing practices. The...

NY’s Medicaid Payment Reforms Aim to Reduce Hospital Use

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The state of New York is undergoing significant payment reforms within its Medicaid program. In 2014, Governor Andrew Cuomo finalized negotiations with federal agencies to create a waiver that would allow New York to renew $8 million in federal...

How the SMART Act Resolved Medicare Secondary Payer Issues

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The Centers for Medicare & Medicaid Services (CMS) has released its final rule detailing a timeline for the expansion of the Medicare Secondary Payer Web portal, which must meet the requirements of the Medicare IVIG Access and Strengthening...

Audits against Medicare Advantage Organizations Found Subpar

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In order to ensure government funding isn’t used to pay erroneous or fraudulent medical claims, the Centers for Medicare & Medicaid Services (CMS) conducts risk adjustment data validation (RADV) audits among Medicare Advantage organizations....

Are Skilled Nursing Facilities Fraudulently Billing Medicare?

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Skilled nursing facilities are an essential part of improving the health among the elderly and the disabled. However, some skilled nursing facilities and rehabilitation centers have taken advantage of Medicare beneficiaries by fraudulently billing...

Do Medicare Part B Prescription Drug Changes Hurt Rural Hospitals?

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The proposed changes to the Medicare Part B prescription drug program is finding opposition among multiple medical organizations. The Centers for Medicare & Medicaid Services (CMS) will need to address the problems in the new proposed rule...

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