A new report reveals increased use of high-cost Medicare services, leading investigators to suspect upcoding and billing abuse. Providers defend their practices, saying increased costs are partly because of senior care. Read More »
Medicare providers could be facing a $11 billion reduction in reimbursements if the government's sequestration process goes forward, according to an OMB report released today. Read More »
Five years of data from Center for Medicare & Medicaid’s largest experiment in performance-based reimbursement are mixed, but physician groups succeeded in slashing the costs for dual-eligibles. Read More »
What started out as a comparative analysis on reimbursement rates related to catheter-based urinary tract infections (CAUTIs) has opened a huge can of worms concerning hospital datasets and their reliability as performance measurements. Read More »
In a milestone report released today, the Institute of Medicine (IOM) analyzes why the U.S. healthcare system needs a new business-based attitude, and why it struggles to learn from its own data. Read More »
The Centers for Medicare & Medicaid Services' rule on hospital "observation stays" has generated much controversy. The American Health Care Association strikes back with a long list of changes that should be made--and why. Read More »
When it comes to getting Medicaid assistance for long-term care costs, too many rule variations among the states have created a chaotic system, a GAO report concludes. Read More »
Ohio is the latest state to launch a pay-for-quality program for skilled nursing reimbursement. But with 10 percent of reimbursement riding on passing the quality program, is the test tough enough? Read More »
As Medicare and Medicaid programs grow, the insurance market is spending billions to get a larger slice of the government-backed healthcare markets. Read More »
As reimbursement becomes increasingly tied to clinical quality and performance, Ohio joins the list of states that are trying a bigger carrot instead of the stick. Read More »
The billing differences between inpatient and observation hospitalizations are causing plenty of headaches, but the American Health Care Association believes CMS’ new pilot program is a step in the right direction. Read More »
A growing number of seniors who have observational hospital stays are getting stuck with the bill for their SNF care. CMS is launching a new pilot to try to iron out the wrinkles in the claims system. Read More »
Seniors in seven states soon will need prior authorization for powerchairs under Medicare. The homecare industry voices its disappointment in the lack of physician documentation standards for authorization. Read More »
Home healthcare agencies are the focus of $5 million in suspect Medicare claims, according to this week's report from the Office of Inspector General. Read More »
The Centers for Medicare & Medicaid Services is finally set to begin a three-year project to reduce fraud and errors by using RACs to check Medicare claims before they move to the payment stage. Read More »
As states debate whether to adopt Medicaid expansion or not, the latest public health study from Harvard suggests expansion might be a healthy idea. Read More »
CMS will increase prospective payment system pay rates to skilled nursing facilities by almost 2 percent, based on its yearly rate adjustment report. Read More »
HHS has announced a public-private collaboration aimed at stemming healthcare fraud. Tougher sentences, suspended payments and enhanced screenings are tools now available for enforcement through the Affordable Care Act. Read More »
The Department of Health & Human Services has released the LTC chapter in the national plan to reduce infections: C. difficile and urinary tract infections are the first of many high-priority targets. Read More »
It was a large group of states with GOP governors whose challenge of the ACA led to the Supreme Court’s ruling, and many of them have either decided, or reportedly may decide, to forgo the additional federal payments that would come from expanding Medicaid eligibility in their states. Read More »
What tops your retirement wish list? Most retirees would gladly trade the dream of a beach house in Florida for lower healthcare and prescription drug costs, as well as more education on financial planning, an insurer survey shows. Read More »
A stunning 99 percent of nursing home records examined by the OIG failed to meet one or more of the federal guidelines for assessing and documenting the use of antipsychotic drugs. Read More »
While trying to save on prescription costs, seniors in the Medicare Part D doughnut hole are skipping or reducing their maintenance medications for depression, chronic heart failure and diabetes, among other chronic conditions, recent data suggests. Read More »
The Centers for Medicare & Medicaid Services has proposed policy changes that would increase reimbursement rates for end-stage renal disease services. Performance data collected next year would affect the payment rates starting in 2015. Read More »
In Connecticut, the state has given permission to its corrections commissioner to release the sickest and most frail inmates to palliative or hospice care. Read More »
