A bipartisan group of lawmakers have introduced a bill in the U.S. House of Representatives that would correct some of the glaring issues around Medicare physician reimbursement and the rate-setting process.
Physician groups have complained for years that certain aspects of the rate-setting process have undermined physicians' Medicare...White Papers, E books, Reports and more
A new analysis from the Medicare Payment Advisory Commission (MedPAC) suggests physician participation in Medicare Advantage (MA) remains widespread nationwide, even as network turnover and contracting dynamics continue to shape how beneficiaries experience access to care.
MedPAC’s review of the 2023 MA market found a large...National News
At its December 4 meeting, the Medicare Payment Advisory Committee (MedPAC) reviewed payment data on payment adequacy and potential payment updates and recommendations for its March 2026 report to Congress. This discussion included an update on post-acute care payments and an assessment of hospital performance.
MedPAC commissioners...National News
Earlier this month, the Medicare Payment Advisory Committee posted its presentation on the association between changes in Medicare Advantage enrollment and hospital finances.
The analysis, presented at the MedPAC September meeting, found that increases in Medicare Advantage enrollment are not associated with significant profit margin...White Papers, E books, Reports and more
Last week, the Medicare Payment Advisory Committee (MedPAC) published its June report to Congress.
The annual June report, which makes recommendations to Congress outlining recommendations for Medicare payment systems, included several areas of interest. These included supplemental benefits and home health care use in Medicare...National News
The Medicare Payment Advisory Committee (MedPAC), which advises Congress on Medicare policy, submitted its annual March report to Congress and included a number of suggestions for payment policies, including tying payment increases to the Medicare Economic Index (MEI).
The report specifically suggests tying it to the MEI "minus one...National News
Co-insurance represented half of all fee-for-service (FFS) Medicare outpatient payments at Critical Access Hospitals (CAHs) in 2022; the full cost for outpatient services was billed as coinsurance in 4% of claims. In 2022, 1.9 million Medicare beneficiaries, or their Medigap plan, were billed an average of $1,750 in cost sharing for CAH...White Papers, E books, Reports and more
A new report from the Medicare Payment Advisory Committee (MedPAC) demonstrates that Medicare Advantage expansion is having a negative effect on hospital finances as MA-related revenue is lower than that of fee-for-services.
The MedPAC report reviewed claims data for 24 million beneficiaries enrolled in both MA and FFS and found that...
MedPAC is concerned about the adequacy of fee-for-service (FFS) Medicare rates and the sunsetting of participation bonuses for clinicians in advanced alternative payment models (A-APMS). Commissioners also discussed the Medicare Advantage PA problem, considered how to lower FFS rates for inpatient rehabilitation facilities and much more...
Last Friday, the Medicare Payment Advisory Committee (MedPAC) sent its recommendations to Congress, including updates for the 2025 Medicare payment systems. In its recommendations, the committee warned that Medicare Advantage policies are increasingly costly to the Medicare program.
At the top, it recommended a 1.5% raise for hospital...National News
The Medicare Payment Advisory Committee (MedPAC) met last Thursday to discuss recommendations for Medicare-related payment rates as Congress and the Centers for Medicare and Medicaid Services (CMS) gear up to address industry reimbursement in 2025.
The committee recommended raises for the hospitals and physicians but wants lower base...National News
Another new year, another report from the Medicare Payment Advisory Commission (MedPAC) saying that Medicare Advantage is more expensive in exchange for lower quality coverage.
This year, the commission found that the federal government will pay Medicare Advantage (MA) insurers $88 billion more than it would if their share of...National News
The Medicare Payment Advisory Committee (MedPAC) published its draft recommendations for Medicare's fee-for-service payment policies and largely renewed its call to substantially limit pay boosts for physicians, hospitals and nursing homes.
The draft recommendation includes a recommendation to give physicians a 1.3% pay increase in...
As the nursing home industry pushes back on the Biden administration's proposal for mandatory federal staffing minimums, a new study suggests the U.S. may want to pivot away from recruitment and towards staffing retention in order to stabilize staffing rates.
Last month, Medicare proposed a new rule that would require long-term care...
The Medicare Payment Advisory Committee (MedPAC) released its 2023 summer data book on spending for the Medicare program. The report includes data across the program including demographics, access to care, quality of care metrics, dual-eligibility data, alternative payment models, and prescription drugs.
The Medicare program was the...CMS Rules
The Centers for Medicare and Medicaid Services (CMS published its proposed physician fee schedule (PFS), which add up to a 1.25% decrease in pay for Medicare physicians for 2024. Physician groups and industry leaders met the news with frustration, with some doubling down on calls to reform the entire payment formula. CMS also posted the...
Congress is moving to address glaring payment issues for the Medicare program; some lawmakers have mobilized by taking aim at the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
For years, there has been an ongoing battle between the Medicare program and physicians who bill the program for payment. Too many options...
The Medicare Payment Advisory Commission (MedPAC) published its annual June Report to Congress, which includes suggestions to unify payment methodologies for post-acute care, address issues within Medicare Advantage, and lower telehealth payments.
The MedPAC recommendations for streamlining payment methodologies for skilled nursing...
A new study by University of Southern California (USC) Leonard D. Schaeffer Center for Health Policy and Economics estimates that overpayments to Medicare Advantage plans could exceed $75 billion annually or 20% of total payments.
The report doubles overpayment estimates made by the Medicare Payment Advisory Commission (MedPAC), which...
The Centers for Medicare and Medicaid Services (CMS) published the FY 2024 Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH PPS) rule updates. The rule includes a 2.8% raise in operating payments for acute care hospitals.
The proposed rule updates Medicare payments and policies...
