The government is publicly reacting to the disruption in healthcare services caused by the Change Healthcare cyberattack and subsequent extended outage, but tangible consequences for UnitedHealth Group have yet to emerge.
The House Energy and Commerce Committee met this week to discuss the attack, but according to Modern Healthcare,...
The Biden administration brought down the hammer on Medicare Advantage insurers and their brokers when the Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Advantage Part D final rule last Thursday.
The rule increases regulatory scrutiny on prior authorization, network adequacy standards and marketing for...
The Centers for Medicare and Medicaid Services released the proposed rule for 2025 hospice reimbursement including a 2.6% raise in per diems and two new quality measures.
The 2.6% net increase would amount to a $705 million increase from FY 2024, including a 3% market basket update and a 0.4% cut for productivity. According to the...Top of The Day
Accountable care organizations (ACOs) and their practices have taken on the full focus of Medicare's value-based care initiatives through the Medicare Shared Savings Program (MSSP) and the ACO Realizing Equity, Access and Community Health (ACO REACH) programs.
A new study published in the JAMA Health Forum looks at survey results from...Arizona News
UnitedHealth Group (UHG) this week is scrambling to remain the victim in the cyberattack that knocked subsidiary Change Healthcare offline for over three weeks, preventing payment for services to providers and disrupting prior authorization requests and pharmacy business nationwide.
On Tuesday, the company announced that it is now in...
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...