It is not too late to sign up and attend the annual Arizona Medical Group Management Fall Conference at the Sheraton Wild Horse Pass Resort. The event kicks off with a networking happy hour on Wednesday evening, October 17th. Of course, I will be...Arizona News
Hospitals say getting paid for previously uninsured folks has saved them from potential closure. The Goldwater Institute says hospitals are raking in the dough by also raising rates on the commercial side.The Arizona Hospital and Healthcare Association (AzHHA) publishes a report that tracks uncompensated care trends for Arizona...National News
The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday, almost 1,300 providers have signed themselves up to test-drive the Bundled Payment for Care Improvements (BPCI) advanced model.
Among the Arizona participants are:
Desert Institute Spine Care
Desert Orthopedic Specialists
Flagstaff Medical...Arizona News
Speaker of the House Paul Ryan, on Monday said "Medicare for all" initiative shows that the Democratic party "has gone off the rails," despite many congressional Democrats not quite so gung-ho about the idea. The "Medicare for all" bill is Sen. Bernie Sanders' crown jewel of healthcare policies, a program that would essentially shift the...National News
The National Association of ACOs (NAACOS) Fall 2018 conference kicked off with a discussion about MSSP ACOs relationships with private payers.
The strategy is payer-neutral - take care of patients regardless of the payer.
According to NAACOS more than 20 million lives are covered under commercial Medicare and Medicaid, and a...Arizona News
Lawyers representing over 34,000 inmates, whom are challenging the quality of healthcare in Arizona's prisons, are looking for another $1.6 million from the state in additional litigations fees. Since filing the lawsuit in March of 2012, the prisoner's attorneys have incurred $6.1 million in legal costs.
Following the 2014...National News
Opposition to the rule was swift, a broad coalition of healthcare organizations and advocacy groups have joined to block the proposal by the Department of Homeland Security.
According to Modern Healthcare, the American Hospital Association, America's Essential Hospitals, the American Academy of Family Physicians, and the American...National News
A final order was issued on Oct. 5 to the Centers for Medicare & Medicaid Services (CMS) to pay Montana Health Co-op over $1.2 million after a Sept. 4 ruling stating insurers are entitled to cost-sharing payments under the Affordable Care Act (ACA).
Judge Elaine Kaplan of the Court of Federal Claims sided with Montana Health...Arizona News
The Office of the Inspector General (OIG) recently discovered $5.7 billion in unreasonable and unnecessary payments to inpatient rehabilitation facilities (IRFs) after a sample audit. The review was prompted by Medicare spending of about $7 billion on IRF stays in 2013, leading the OIG to question the payment system.
The OIG sampled...National News
The Centers for Medicare & Medicaid Services (CMS) issued a notice on Friday, Oct. 5 looking to increase oversight of nursing home staff to ensure attendants are showing up to care for seniors in their home and prevent cases of elderly abuse or unlawful actions.
CMS stated in its notice that it's seeking to propose a rule that...Arizona News
In May, a final rule from the Centers for Medicare & Medicaid Services (CMS) opened the doors for Medicare Advantage (MA) insurers to offer long-term care benefits to members. About 7.5 percent of MA plan enrollees in 2019 may have access to in-home support services or extra benefits, according to CMS officials.
In a speech...Arizona News
The largest orthopedic practice in Arizona adds to its facility list a 6,500 square foot space hosting all orthopedic specialties in the Northeast Valley at 90th Street and Shea Blvd.
In addition to its practice locations, The CORE Institute has physical therapy locations, two spine centers and an orthopedic specialty hospital.
Its...Arizona News
The insurer is seeking 90 full-time employees. Positions are available at its Humana Pharmacy operations center in Glendale; dispensing facility in Phoenix; and call center located in Tempe.
Humana is hiring for Inbound Customer Service Representatives, Utilization Management Administration Coordinators, Pharmacy Technician and...National News
A new analysis from the Association for Community Affiliated Plans (ACAP) focuses on new models implemented by safety-net plans and the best way high-quality coordinated care can be provided for individuals with substance abuse disorder (SUD).
Successfully managing the needs of people with SUD requires a high-level of comprehensive...Arizona News
On Friday, September 28, The Centers for Medicare & Medicaid Services (CMS) announced that Medicare Advantage (MA) premiums will decrease by six percent, on average, in 2019. Additionally, plan choices and new benefits are expected to increase as MA enrollment reaches new highs.
According to a statement from CMS, more than 36...Arizona News
Democratic gubernatorial candidate David Garcia sat down with Maria Polletta, Arizona Republic reporter, on Thursday for a live interview to help Arizonans gain better insight on Garcia's policies and what his administration would look like if voted into office.
Running up against Republican incumbent Gov. Doug Ducey, the...National News
Former Apple CEO John Sculley spoke out last week about the key role Amazon could play in the healthcare industry. The conglomerate partnership between Amazon, Berkshire Hathaway, and JP Morgan Chase & Co. has turned the heads of many in the three-trillion dollar industry, but little is known as to what exactly they have in store for...Arizona News
CNSI, a health information technology (IT) company based in Maryland, developed the nation's first automated real time and cloud based Medicaid Management Information System (MMIS) in Michigan.
The initial term of the contract will be for three years, with two, one-year options to extend, not to exceed five years.
Other bidders...National News
The settlement announced October 1 resolves DaVita from False Claims Act liability for providing inaccurate information that caused Medicare Advantage plans to receive inflated Medicare payments.
DaVita voluntarily disclosed to the feds practices instituted by HealthCare Partners, a large California-based independent physician...Arizona News
Dr. Whelan now has oversight of Banner – University Medical Center Tucson, Banner – University Medical Center South, dozens of clinics, the Banner – University Medical Group physician practice plan in Tucson and more than 6,000 Banner Health employees in Southern Arizona.
In a press release, Banner touts Whelan's decades...Arizona News
A discussion with The Hertel Report Publisher Jim Hammond on the most important stories we covered the week ending September 28, 2018.
Click on the microphone below to listen to the conversation moderated by Veronica Graff, a contributor to The Hertel Report.
...
At issue is the CMS rulemaking process and whether the agency must use notice and comment rather than issue its own interpretations of federal law.
The U.S. Supreme Court agreed to review a 2017 court ruling by Federal Appellate Judge Brett Kavanaugh after he ruled that when CMS changed its Medicare payment formula for...
Tennessee is now the fourth state to introduce a work requirement proposal for Medicaid enrollees, joined by Alabama, Michigan, and Virginia who also posted their proposals this month.
The waiver would require enrollees to seek or maintain work in order to keep Medicaid benefits. The state's requirements will specifically focus on...National News
A group of laboratories lost their challenge against the definition of "applicable laboratories" under the Protecting Access to Medicare Act of 2014 because did not account for a majority of hospital labs when calculating Medicare reimbursements.
At stake were billions of dollars in Medicare reimbursements that federal judge Amy...National News
The two-week extension comes after targeted review by clinicians, groups, and APMS reviewed their MIPS payment adjustment factor(s),and determined errors in the program's payment adjustment calculation.
Concerned included the application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances...
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