Beginning next week, every skilled nursing facility in the country will undergo a five-claim audit as the Centers for Medicare and Medicaid Services (CMS) aims to get improper payments under control. Meanwhile, nursing homes are expressing concern about the effects that Medicaid redeterminations and subsequent disenrollment's could have...
As states proceed with Medicaid redeterminations after three years of a pause on eligibility review, hundreds of thousands of Americans are losing insurance coverage, according to early data reports. The Centers for Medicare and Medicaid Services (CMS) are stressing the importance of limiting the number of lost enrollees and facilitating...White Papers, E books, Reports and more
A new study shows that dually eligible Medicare Advantage enrollees received poorer clinical care than those who were not dually enrolled.
The Centers for Medicare and Medicaid Services (CMS) Office of Minority Health (OMH) released a report this week based on analysis of Healthcare Effectiveness Data and Information Set (HEDIS),...CMS Rules
The Biden administration issued a proposed rule through the Centers for Medicare and Medicaid Services that aims to increase transparency of prescription drug costs and managed care plan operations for Medicaid enrollees.
It would do this by implementing a new drug price verification survey tool and requiring the inclusion of drug...National News
Support for Medicare coverage of the anti-Alzheimer's drug Leqembi is growing on Capitol Hill, but estimates of the drug's cost may prove to be prohibitive for the Medicare program.
Coverage of the drug through the Medicare program would raise costs for the program by $2 billion to $5 billion per year, according to a new study by...National News
A new report revealed dozens of examples in which medical care for pregnant patients was different than care they would have received before the Supreme Court overturned Roe v. Wade last June.
The report was conducted by the University of California at San Francisco's Advancing New Standards in Reproductive Health (ANSIRH) research...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) published a memo concerning a crackdown on improper claims for skilled nursing facilities. CMS also announced that it would begin a demonstration for inpatient rehabilitation facilities in Alabama that will allow all Medicare claims to be subject to review.
As of June 5, all SNFs...
Today is the last day of the COVID-19 public health emergency (PHE), and policies are rapidly shifting to accommodate the post-pandemic healthcare landscape in the U.S.
On Tuesday, the Drug Enforcement Administration (DEA) announced that it would continue allowances for telehealth companies to prescribe controlled substances for six...
The Medical Group Management Association (MGMA) published a report last week on the issues brought about by Medicare Advantage (MA) plans' use of prior authorization.
MGMA surveyed 600 medical groups on the use of PA and found that it contributes to increased costs and delays or denials of care. Groups overwhelmingly reported that...National News
Last week, the Centers for Medicare and Medicaid Services (CMS) proposed two new rules that would require private entities that manage Medicaid and Children's Health Insurance Plan (CHIP) plans to enforce national maximum standards for appointment wait times and will require managed care organizations (MCOs) to monitor compliance.
The...National News
As pressure mounts from stakeholders and lawmakers, Eli Lilly, producer of the experimental Alzheimer's antibody drug donanemab, is saying that it expects the Centers for Medicare and Medicaid Services (CMS) to reverse its prohibition of anti-amyloids.
A bipartisan group of nearly half of U.S. state attorneys general sent a letter to...News
Arizona Attorney General Kris Mayes told the Arizona Supreme Court that her office's decision to not enforce a Territorial era abortion ban means that no one can enforce the ban. The U.S. Department of Health and Human Services (HHS) has launched an investigation that could lead to enforcement of the Emergency Labor and Transport Act...
Humana has revised its outlook, confident that its expected Medicare Advantage enrollment will increase even more than it originally anticipated in 2023. But Centene has reported the opposite, expecting to lose money in Medicare Advantage and from Medicaid redeterminations.
Centene released its first quarter (Q1) corporate reports on...
The first Medicaid redeterminations since the beginning of the COVID-19 pandemic have been underway in at least five states since the beginning of the month. Health advocacy groups are pressuring U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra to ensure that a "health equity and civil rights disaster" does not...
Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms.
The rule stipulates that once a health plan grants prior authorization for a service, the approval will...
Published Friday, the rate notice includes a 3.32% overall pay raise which was up from the 1.03% in the proposed rule.
The Centers for Medicare and Medicaid Services (CMS) appears to have ceded to the demands of the insurance industry; the new pay rates translate to a $13.8 billion increase for insurers, according to Axios, CMS will...
On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed the FY 2024 Skilled Nursing Facility (SNF) Payment Prospective Systems (PPS) rates. It includes an increase of 3.7%, or $1.2 billion in Medicare Part A payments to SNFs.
The rate increase reflects a 6.1% market basket update to the payment rates comprised of a...
On Friday, the Centers for Medicare and Medicaid Services issued a proposed rule that would give hospice providers a 2.8% reimbursement increase and would institute a number of penalties for hospices that fail to meet reporting requirements. The rule signals a long-expected federal crackdown on hospice fraud, waste and...
New research shows 83% of entries in provider directories from America's leading insurers were inaccurate.
Most providers listed in directories from Aetna, Elevance, Cigna, Humana, and UnitedHealth had inaccuracies, but specialty information was much more likely to be accurate. Only 27.9% of physicians had consistently accurate...
Lawmakers and stakeholders are still very upset with the U.S. Department of Health and Human Services' (HHS) plan to cut payments to the Medicare Advantage (MA) program and to enforce regulations against MA plans that have benefitted financially from improper overpayments. This week, HHS Secretary Xavier Becerra defended the rule in two...
