The Trump administration's Medicare proposals could mean big changes how physicians are compensated. A standard cold and Stage 4 cancer would offer doctors identical payments regardless of a patient's medical complexities.
Essentially, the government would pay one of two rates depending on if the patient is new--higher rate--or...National News
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patient Communities Act received an overwhelming amount of support from representatives, passing in a 396-14 vote.
This legislation approved by the House on Friday will give various federal agencies the resources they need to combat...National News
The new model may save the Medicare program more than $180 million by keeping beneficiaries healthy and averting new cases of diabetes.
According to CMS, Medicare spends more than $104 billion every year treating patients with this preventable disease.
The Medicare diabetes prevention program was launched in 2012 as a small,...Arizona News
Banner Health has agreed to pay the United States over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.
The settlement resolves allegations that 12 Banner Health hospitals...Arizona News
Effective immediately, Health Net will not be quoting any more new business for small and large business health plans.
Health Net stated in a letter to brokers:
We want you to know that Health Net will honor all current group contracts and continue to provide high quality service to our members. Employer groups and members will...Arizona News
Outpatient clinics opening soon, as two key payers added.
Cancer Treatment Centers of America, based in Goodyear, Ariz., is expanding its Valley network with the opening of two Outpatient Care Centers this month, with a third Valley location planned later this year.
Raj Garg, MD, JD, President and Chief Executive Officer, Cancer...National News
In April, the government will start sending out new Medicare cards, a yearlong effort to change how 59 million people enrolled in the federal program are identified.
In the past, Medicare ID cards have been stamped with the Social Security numbers of enrollees, about 50 million seniors and 9 million people with serious disabilities....
For patients without smartphones, staffers at participating physicians' offices can schedule their rides for immediate pickup or dropoff up to 30 days in advance.
Rather than operating through an app, Uber Health will send passengers their ride information via text message. Drivers, however, will still locate and pick up riders...
Trump's budget proposal suggested CMS assess clinician performance using claims data and patient surveys, eliminating the need for physicians to report.
MIPS is one of two payment tracks established under the Medicare Access and CHIP Reauthorization Act of 2015, which lays out how Medicare, the largest payer in the United States,...
The 2019 budget requests hits insurer and payer hot spots including ACA Medicare risk corridor payments and cost-sharing reductions, uncompensated care payments, Medicare post-acute care costs and even graduate medical education.
Trump’s proposal outlines his administration’s priorities – Congress makes the decisions.
Budget...National News
Hospital prices increased 2.2 percent in December, the fastest rate in four years, according to an analysis by Altarum, a nonprofit health-care research organization.
The group analyzes data from the Bureau of Labor Statistics and other sources to estimate the underlying prices that health plans and consumers pay for medical goods...
L.E.K. Consultants release white paper after in-depth analysis.
L.E.K. Consulting’s proprietary county-level projection model shows Medicare Advantage enrollment rising from roughly 20 million, or 35% penetration, at the end of 2017 to approximately 38 million, or 50% penetration, by the end of 2025. Nor will it stop there....
The Medicare Payment Advisory Commission (MedPAC) voted 14-2 to in favor of killing the Merit-based Incentive Payment System (MIPS) and replacing it with an alternative model of reimbursement.
MedPAC Chairman Francis "Jay" Crosson of Palo Alto, California, said he wished the commission had made its recommendation sooner, but it had...
While the Affordable Care Act’s fifth open enrollment season is off to a surprisingly good start, many uninsured people said they weren’t even aware of it, according to a Kaiser Family Foundation survey.
Kaiser Health News reports open enrollment started Nov. 1 and runs through Dec. 15 in most states. Advocates fear enrollment...National News
The Republican tax plans are looking a lot more like health-care bills, with provisions that may affect coverage and increase medical expenses for millions of families.
Bloomberg reports the House version of the tax bill would end a deduction that allows families of disabled children and elderly people to write off large medical...National News
Not everyone will be happy.
November 2 the Centers for Medicare and Medicaid Services exposed the final rule implementing the changes. The rule is 1,250 pages long. You may wish to read it here. Thoughtfully included are the names and phone numbers of staff that can be contacted for more information , listed by topic areas.
For the...
The complaint alleges that Epic refused to adjust its billing software after the Centers for Medicare & Medicaid Services changed the way hospitals bill for anesthesia, prompting hospitals that use its software to improperly bill Medicare and Medicaid.
The whistleblower in the lawsuit, Geraldine Petrowski, worked as a compliance...
Payment reform is critical to building a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.
The Health Care Payment Learning & Action Network (LAN), is a public-private partnership launched in March 2015 to drive adoption and alignment of Alternative Payment Models...National News
Moody's Investor Services notes 2016 expenses grew faster than revenues.
“Tighter margins will weigh on the sector going forward as reimbursement pressures and expenses increase.”
After years of cost containment, annual expense growth of 7.2% widely outpaced annual revenue growth of 6.0%.
Pension funding gaps...News
The federal agency also released a Request for Information to inform its future rule making impacting inpatient and long-term hospitals
The Centers for Medicare & Medicaid Services (CMS) has proposed updating its 2018 Medicare payments and policies and is seeking comments on the proposed rule and RFI through June 13, 2017.
"We...
