Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

Is the Medicare Part B Proposed Rule ‘Bad Medicine’?

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Two months ago, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed rule that would create new payment models meant to reimburse providers for assigning prescription drugs. This would change the payment structure of...

Did the Affordable Care Act Lower Medicare Spending?

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The Affordable Care Act and other regulatory changes were meant to reform the healthcare industry and save costs on wasteful spending. Recent results coming from the Department of Health and Human Services (HHS) show that the Affordable Care...

End-of-Life Counseling Sessions Stall despite Medicare Payment

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Starting in January 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing physicians for conducting end-of-life and advanced care planning discussions with patients who are Medicare beneficiaries. Doctors are able to...

How the ACA Increased Enrollment in Medicaid and CHIP Programs

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Last Friday, the Centers for Medicare & Medicaid Services (CMS) released a report covering the state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data for the month of February. This type of information...

MACRA Rule Revolutionizes the US Healthcare Payment System

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Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rulemaking regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation has made a significant difference to the...

New Proposed MACRA Rule Renovates Information Technology Use

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The Department of Health & Human Services (HHS) has proposed new rules regarding the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) which will essentially remove the meaningful use program and move forward in advancing health information...

How CMCS Improved Managed Care in State Medicaid Programs

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Earlier this week, the Centers for Medicaid and CHIP Services (CMCS) finalized its ruling on the managed care Medicaid reimbursement regulations. Soon afterward, the National Association of Medicaid Directors (NAMD) released a statement regarding...

CMS Rule Renovates Coverage beyond ACA’s Medicaid Expansion

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The Medicaid program has greatly changed since the passage of the Obama administration’s Affordable Care Act. Most importantly, more than half of the states throughout the nation have implemented Medicaid expansion, which means that more...

SNF Medicare Reimbursement Expected to Rise by $800 Million

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Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that changes the Medicare reimbursement policies at skilled nursing facilities for 2017. Essentially, the proposed rule further brings Medicare payments...

CMS Releases Medicare Data for Quality-Based Metrics

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The Centers for Medicare & Medicaid Services (CMS) is further attempting to innovate and improve medicine through quality-based metrics, as the CMS Office of Minority Health has released new data that provides more information on the quality...

Primary Care Payment Reform Targeted in Multi-Payer Initiative

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The Centers for Medicare & Medicaid Services (CMS) are renovating how primary care is delivered throughout the United States. According to a news release from the agency, CMS is launching a program called the Comprehensive Primary Care Plus...

Arizona Declines Funding Children’s Health Insurance Program

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Nearly 20 years ago, the Children’s Health Insurance Program (CHIP) was established in order to ensure the offspring of low-income families who didn’t qualify for the Medicaid insurance plan did have the right to healthcare coverage....

CMS Ruling Changes Medicare Advantage and Part D Programs

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Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced in a press release new changes taking place for the Medicare Advantage and Part D Prescription Drug Program starting in 2017. Essentially, these deviations are meant...

How Medicaid Expansion Improves Behavioral Healthcare Access

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When the Patient Protection and Affordable Care Act was passed into law, it established that Medicaid expansion across all 50 states would take place. However, a Supreme Court ruling created a clause that allowed Medicaid expansion to be optional...

Medicaid Challenges with Value-Based Care Payment Models

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With the federal government and the healthcare industry as a whole focusing their efforts on adopting value-based care payment models that revolutionize medical care, it should come as no surprise that the National Association of Medicaid Directors...

HHS Issues Medicare Coverage Expansion for Diabetes Prevention

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One of the most common chronic medical conditions found today is that of diabetes. Healthcare providers and payers need to work together to find ways that could help reduce the rates of diabetes nationwide. Recently, the Department of Health...

Will Changes in Medicare Part B Drug Prescribing Cut Costs?

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The Centers for Medicare & Medicaid Services announced last week that new healthcare payment models would be utilized in Medicare Part B drug prescribing practices. These innovative reimbursement strategies are expected to bring down the...

4 Health Payer Industry News Items Revealed at HIMSS16

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With the 2016 HIMSS Conference and Exhibition closing its doors, it grows important to address how the health payer industry remains vital to both the ongoing technology advancements in medicine and patient care in general. Below we outline some...

4 Elements Necessary for Switching to ICD-10 Diagnosis Coding

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On October 1, 2015, the healthcare industry from payers and federal agencies to hospitals, physicians, and specialists transitioned to ICD-10 diagnosis coding. Many healthcare providers were concerned that their practices would not be prepared...

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies

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Healthcare access among Medicare and Medicaid beneficiaries remains a top priority for the Centers for Medicare & Medicaid Services (CMS). In 2015, CMS listened to the concerns of many beneficiaries and discovered that many do not have efficient...

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