Medicare has continued to make overpayments for chronic care management services, and as a result, has cost the program and its beneficiaries millions of dollars in waste.
The Office of the Inspector General (OIG) examined over 7.8 million claims from physicians and 240,00 claims from hospitals for chronic care management services...National News
This week, industry stakeholders discussed value-based care as it pertains to their business and said in no uncertain terms that the path forward for healthcare is through value-based care, with the Centers for Medicare & Medicaid Services' (CMS) alternative payment models (APMs) leading the way. Skilled nursing facilities and...Arizona News
New data released by the Centers for Medicare and Medicaid Services (CMS) showed that more than 2.5 million people enrolled in health coverage on HealthCare.gov and state Marketplaces during the 2021 Special Enrollment Period (SEP), which will close on August 15th.
Enrollment increased by about 404,000 nationwide in July 2021....National News
Social Determinants of Health (SDOH) may have a more significant influence on health outcomes than clinical care. The focus on SDOH reflects broader trends in the U.S. healthcare system.
Food access, transportation options and other SDOH account for up to 55% of an individual’s health outcomes. To better understand these factors,...CMS Rules
The Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH) received a new final rule from the Centers of Medicare and Medicaid Services (CMS) this week. The rule helps providers by dropping a requirement that would have forced hospitals to disclose their contract terms...
The special enrollment period for individual health care plans offered through the Affordable Care Act has been a boon for major health insurers participating in the Marketplace. But many insurers are concerned that extending the SEP could cause unintended issues for insurers and enrollees alike. Also, the Brookings Institute says that...
According to a new study from the Centers for Disease Control and Prevention, nursing aides are the most likely to interact with long-term care residents but are the industry's least likely workers to be vaccinated against COVID-19.
Concerning Statistics
CDC researchers looked at data from 300 U.S. facilities and found that...White Papers, E books, Reports and more
According to a new report from the Government Accountability Office (GAO), Medicare Advantage beneficiaries in their last year of life transition to fee-for-service coverage at least twice as often as those who are expected to live longer. Healthcare costs associated with those patients were an estimated $422 million higher in 2016 than...National News
A new bill introduced by Representatives Suzan DelBene (D-Wash.), Peter Welch (D-Vt.), Darin LaHood (R-Ill.) and Brad Wenstrup (R-Ohio) looks to reverese Trump-era modifications to the Medicare Accountable Care Organization (ACO) program and restore higher cost savings to participating providers while removing some of the risk. The bill...Arizona News
Across the board, medical groups, hospitals and health care personnel are requesting institutional vaccination mandates for healthcare workers as the Delta variant spread increases case counts and hospitalizations nationwide.
The American Medical Association (AMA) and the American Nurses Association (ANA) were joined by 58 other...CMS Rules
The Centers for Medicare & Medicaid Services (CMS) have recently taken steps to correct Stark Law, and released an advisory this week that applies to physician groups providing services through wholly owned subsidiary practices that are separately enrolled in Medicare.
The federal physician self-referral law, popularly known...CMS Rules
The Centers for Medicare & Medicaid Services (CMS) included provisions to expand reimbursement for telehealth services for mental and behavioral health care in the proposed 2022 Physician Fee Schedule released Tuesday. The proposal includes paying providers for audio-only services.
Telehealth use was widely expanded by CMS...Arizona News
At AHCCCS' quarterly Arizona State Medicaid Advisory Committee (SMAC) meeting, members discussed continued Public Health Emergency (PHE) funding and other funding priorities.
AHCCCS now serves 2.2 million Arizonans, and over the last 17 months enrollment has grown by 373,000 - which is due to a condition of the enhanced federal match...
Despite vaccinating most residents against COVID-19, the decline in cases and deaths in nursing homes, and the relaxation of some visitation restrictions, residents and families continue to face limitations on visitation.
In January, the Consumer Voice released a report detailing the horrific impact of lockdowns on nursing home...
On July 12, AHCCCS submitted a proposal to the Centers for Medicare and Medicaid Services (CMS) detailing its plan for reinvesting federal funding made available through the American Rescue Plan Act (ARPA).
The spending plan includes strategies that aim to strengthen AHCCCS’ existing home and community based services (HCBS) program...
Last Thursday, the U.S. Department of Health and Human Services (HHS) issued an interim final rule that aims to protect consumers from surprise and balance billing practices and restricting out-of-pocket costs. Surprise billing was a major campaign concern for both presidential candidates and the Biden Administration is acting on...
This week, skilled nursing facilities are finding new pathways to value-based care and the Medicare Access and CHIP Reauthorization Act (MACRA) is under review for incentives. While ACOs have been struggling, the American Medical Group Association recommended several ways to improve them in a letter to the Centers for Medicare &...
Last Friday, the U.S. Supreme Court announced it would hear arguments for American Hospital Association v. Becerra, a case that deals with cuts made by the Centers for Medicare & Medicaid Services (CMS) to the 340B Discount Drug Program.
The American Hospital Association (AHA) along with the Association of American Medical...
This week, CMS announced Dr. Meena Seshamani, M.D., Ph.D. as Deputy Administrator and Director of Center for Medicare. Dr. Seshamani will lead the Center’s efforts in serving people 65 and older, people with disabilities and people with End-Stage Renal Disease that rely on Medicare coverage. Dr. Seshamani started her new position on...Arizona News
The Centers for Medicare & Medicaid Services (CMS) withdrew federal approval for the Arizona Health Care Cost Containment System's (AHCCCS) Medicaid work requirement program, the AHCCCS Works Community Engagement Program. The waivers were approved under the Trump administration and similar work requirements from other states were...