This week saw further fallout from the Change Healthcare cyberattack, this time affecting local Arizona providers and the Merit-based Incentive Payment System (MIPS) data submission window. On Wednesday, the HHS Office of Civil Rights (OCR) launched an investigation of Change Healthcare and UnitedHealth Group (UHG) focused on whether a...
The exact nature of the Change Healthcare cybersecurity incident remains mysterious as concerned parties come forward to voice concerns about Change, UnitedHealth Group and the use of healthcare technologies controlled by large companies.
Last Friday, Change Healthcare announced that it would offer a temporary assistance loan program...Arizona News
Tennessee-based Community Health Systems' (CHS) operational practices are the subject of a new investigation by the U.S. Department of Justice (DOJ). The investigation was made public in a Securities and Exchange Commission (SEC) filing.
The filing said that CHS received a Civil Investigative Demand in January and that the company was...National News
The National Association of Accountable Care Organizations (NAACOS), a nonprofit which represents accountable care organizations (ACOs), uncovered a Medicare fraud scheme that may have cost the government $2 billion.
Federal officials are now investigating the fraudulent billing of nearly 406,000 patients for catheters. The Washington...CMS Rules
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would improve oversight of accrediting organizations (AOs).
Recently, AOs have come under fire for failing to update accreditation of providers and suppliers that fail to meet requirements for the Medicare and Medicaid programs. AOs are...
Regarding inpatient admissions, algorithms or artificial intelligence alone cannot be used by Medicare Advantage (MA) insurers as the basis to deny admission or downgrade to an observation stay; a patient’s circumstances must be considered against the permissible applicable Medicare coverage criteria under which MA operates.
The...
On January 30, the Centers for Medicare and Medicaid Services (CMS) rolled out a new website that it hopes will facilitate value-based care (VBC) uptake and education.
CMS Innovation Center Director Liz Fowler has previously noted that the parameters for "value-based care" have remained elusive to industry stakeholders. In response,...
On Monday, the Centers for Medicare and Medicaid Services (CMS) announced a remarkable increase in participation in accountable care organization (ACO) programs in 2024.
The CMS press release boasts that 19 newly formed ACOs will join the new Medicare Shared Savings Program (MSSP) permanent payment option that grants ACOs $20 million...
The Centers for Medicare and Medicaid Services (CMS) revealed their proposals for Medicare Advantage plans in 2025, but the Biden administration appears to be pulling punches that it otherwise let fly in non-election years.
CMS said on Wednesday that it expects the average benchmark payment for MA plans to decrease by 0.2% in 2025...
A new report by healthcare research firm ATI Advisory determined that the Centers for Medicare and Medicaid Services (CMS) is not doing enough to reconcile incongruities between the Medicare and Medicaid programs for dually eligible beneficiaries in long-term care.
The ATI Report found that the over one million full benefit...
In November, the Centers for Medicare and Medicaid Services (CMS) announced a Notice of Funding Opportunity (NOFO) for the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model.
The AHEAD Model is intended to cut costs for states and improve overall patient health while advancing health equity, according to...
On January 1, Medicare beneficiaries will receive coverage for expanded mental health services; more than 400,000 marriage and family therapists and mental health counselors will be allowed to accept Medicare payments beginning in 2024.
Axios explains that while Medicare has covered psychiatrists, psychologists and social workers, low...
For the third year in a row, a record number of people have signed up for health insurance plans through the Affordable Care Act's (ACA) federal marketplace.
Federal officials estimate that more than 19 million people will enroll in 2024 coverage by the end of the enrollment period in January. According to the New York Times, already...
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would allow Medicare beneficiaries more opportunities to appeal their hospital status, appeal after hospital discharge and a retrospective appeal for a class action lawsuit.
According to the American Hospital Association, the proposed rule is...
More fraudulent sober living home operators were charged by the state of Arizona this week for patient referral kickback schemes. Arizona Health Care Cost Containment System (AHCCCS) Cabinet Executive Officer Carmen Heredia is calling for an overhaul of the state Medicaid system after spending the first year of her position focusing on...National News
Bright Health Group has been ordered to liquidate by a Texas court, which will block the enforcement of risk-adjusted transfer payments in Texas that the company has defaulted on.
According to Fierce Healthcare, Bright agreed to a repayment agreement with the Centers for Medicare and Medicaid Services (CMS) for $89.6 million, or...CMS Rules
This week, federal regulators issued an interim final rule that would take action against states that have not complied with the federal Medicaid eligibility rules or reporting requirements during the redetermination period.
The rule says that the Centers for Medicare and Medicaid Services (CMS) will require noncompliant states to...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule rule, which includes a 3.34% decrease to the schedule's conversion factor, setting it at $32.74, a $1.15 decrease from 2023.
The agency finalized other increases for visits including primary and longitudinal care, and...
The Centers for Medicare and Medicaid Services (CMS) released the CY2024 Outpatient and Ambulatory Surgical Center Prospective Payment System (OPPS), which included an increase for outpatient hospitals and ASCs of 3.1%.
The final rule's raise was larger than the 2.8% initially proposed, which the agency attributed to industry response...
Arizona Health Care Cost Containment System (AHCCCS) is investing $47.5 million from ARP Awards to help strengthen HCBS in Arizona.
Starting on December 4, 2023, eligible HCBS providers can apply for up to $1 million for programmatic or infrastructure projects to improve HCBS for round 2 of the ARP Program Awards. All applications...