In a March 24 ruling, U.S. District Judge Michael Shea granted Medicare patients the constitutional right to challenge hospital decisions putting them on observation status. The class action case favored beneficiaries who had their status changed by hospitals to observation, despite having initially been admitted by...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) is expanding its accelerated and advanced payment program for Medicare providers to support hospitals and doctors on the front lines of the rapidly spreading, global pandemic.
Taking advantage of the recently established Coronavirus Aid, Relief and Economic Security...Arizona News
Director Jami Snyder's March 17 letter to the Centers for Medicare and Medicaid Services asks the agency to waive certain Medicaid and CHIP requirements. Arizona's Medicaid agency also added a new webpage with a list of resources for addressing COVID-19 and a handy FAQ section.
Among the many asks to CMS, the Arizona Health Care Cost...CMS Rules
Following last year’s controversial price transparency rule mandating that hospitals disclose the rates they negotiate with insurers online for specific services, payers have decided to counter the rule with an initiative of their own.
The Centers for Medicare and Medicaid Services (CMS) revealed the list of 70 mandated services...Arizona News
Terms of a settlement agreement will allow Hacienda Healthcare to keep its state license and Medicaid contract under several conditions, including the mandatory hiring of a quality improvement expert.
In June 2019, the Arizona Department of Health Services issued a notice of intent to revoke the facility's license following the...Arizona News
Hospice advocates are calling for a delay to the Centers for Medicare and Medicaid Services' (CMS) Medicare Advantage (MA) carve-in demonstration set to begin in Jan. 2021.
Earlier this year, the agency announced it would start testing hospice care coverage through MA plans in 2021 with the intention of increasing care...Arizona News
National enrollment for 2020 health plans on HealthCare.gov totaled 8.3 million for the open enrollment period ending on Dec. 15. But this year because some consumers attempting to enroll during the final hours experienced issues, the deadline for sign up was extended until 3 a.m. EST Dec. 18.
This year, shoppers seeking health...National News
Despite 2020 presidential candidate debates and lawmakers' crusade on the healthcare industry's business model, pharmaceutical companies, hospitals and insurance companies fared quite favorably as billions in tax breaks line their pockets ahead of the holidays.
Former CMS Administrator Andy Slavitt told the Washington Post,...
A report from the Department of Health and Human Services (HHS) inspector general's office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector...
The Centers for Medicare and Medicaid Services (CMS) recently issued a request for applications (RFA) for two of the three voluntary payment model options, specifying how accountable care organizations can apply to participate in the professional and global options of Direct Contracting (DC).
Defined within DC are three different...CMS Rules
Medicare open enrollment for 2020 coverage ended Saturday, Dec. 7, and while the Centers for Medicare and Medicaid Services (CMS) indicated a special enrollment period (SEP) for seniors who enrolled in a plan based on erroneous information, senators are calling for CMS to specify information regarding the SEP and make it available for...CMS Rules
For the first time in the last decade, the Centers for Medicare and Medicaid Services (CMS) updated the popular health plan shopping tool Medicare Plan Finder, but the recent redesign initiative has raised concerns for consumer advocacy groups that say the tool offers inaccurate information.
The federal government spent $11 million...Arizona News
Hospital prices continue to be scrutinized as employer groups deem costs way too high and pressure from the Trump Administration to publish negotiated prices increases.
According to a Rand report, significant discrepancies were found between what private health plans pay for hospital services versus Medicare, highlighting that...National News
As the Centers for Medicare and Medicaid Services (CMS) considers possible changes to the methodology it uses to calculate hospital star ratings, some experts are worried the proposed adjustments do not adequately account for patient needs.
The agency announced in August plans to update the quality measurement methodology of the...CMS Rules
A new analysis of the decline in hospital readmission rates suggests ties to a drop in hospital admissions all together, rather than a Centers for Medicare and Medicaid Services (CMS) value-based purchasing program as previously credited.
The Medicare Hospital Readmissions Reduction Program (HRRP) is a value-based purchasing...CMS Rules
Medicare beneficiaries will see a 7 percent increase in monthly premiums and annual deductibles for 2020 Part B coverage, which takes care of physician services, outpatient hospital services, explicit home health services and durable medical equipment.
The Centers for Medicare and Medicaid Services (CMS) announces the rates for...CMS Rules
After the publication of the Outpatient Prospective Payment System (OPPS) on Friday, the Trump Administration is holding off on a controversial transparency rule that would require hospitals to publicly post all privately negotiated payer rates. The Centers for Medicare and Medicaid Services (CMS) has promised to issue a "forthcoming...National News
One of the country's oldest nonprofit health insurance plans allegedly exploited Medicare of millions; Seattle-based Group Health Cooperative was taken to federal court in a whistleblower case.
Filing suit against the health plan is one of the company's former medical billing managers, Teresa Ross, who alleges that Group Health...Arizona News
The Department of Health and Human Services (HHS) unveiled a proposal spearheaded by the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) on Oct. 9 to make changes to anti-kickback legislation and Stark Law in an effort to modernize.
In a news release announcing the proposals, HHS...
In a letter dated Oct. 17, the Arizona Health Care Cost Containment System (AHCCCS) notified the Centers for Medicare & Medicaid Services (CMS) that it will postpone implementation of AHCCCS works until further notice, citing ongoing court battles over Medicaid work requirements and the "evolving national landscape concerning...
