Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. The total amount of the penalties is determined by how much each hospital bills Medicare.

Medicare 123

Medicare Medicare Hospitals COVID-19 123

HIT Consultant

SEPTEMBER 14, 2023

What You Should Know: – Out-of-network ground ambulance rides accounted for a larger percentage of ground ambulance claim lines 1 than in-network rides from 2018 to 2022. of all ground ambulance claim lines in 2018 compared to 59.4% of all ground ambulance claim lines in 2018 compared to 59.4% percent in 2018 to 30.6

Hospitals 98

Hospitals Medicare Medicare 98

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

McGuire Wood

MARCH 31, 2022

TELEO Capital Management has announced it has acquired CHCS Services from Capgemini America. Founded in 1989, the company focuses on long-term care and Medicare supplement plans. Capgemini America, based in New York, provides consulting, technology, and outsourcing services. CHCS , based in Pensacola, Fla.,

Medicare 52

Medicare Medicare 52

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. Seema Verma.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Health Populi

JUNE 27, 2022

Declines in preventive care services like cancer screenings and blood glucose testing concern employers, whose continued to cover health insurance for employees during the pandemic. Take preventive services across the entire national commercial population in the study. But flat growth is expected for 2022, Castlight forecasts.

COVID-19 121

COVID-19 Health Insurance Medicaid Medicaid 121

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare It News

JUNE 13, 2023

Uber Health launched its HIPAA-enabled API and dashboard in 2018 to offer logistics services to population health management programs. Soon, these providers will have access to patient benefit data and eligibility files from payers, allowing them to leverage and deploy covered services.

Medicaid 195

Medicaid Medicaid HIPAA Hospitals 195

HIT Consultant

AUGUST 15, 2022

Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. Due to rapid growth of the 65-and-older portion of the population, Medicare expenditures are forecast to reach $1,559.4 – Continued increase in overall Medicare costs. Case in Point.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

Medicare 59

Medicare Medicare COVID-19 Hospitals 59

CMS.gov

NOVEMBER 16, 2018

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Fri, 11/16/2018 - 18:51. Director, Medicare-Medicaid Coordination Office, Topic. Medicare Parts A & B. Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report.

Medicare 35

Medicare Medicare Medicaid Medicaid 35

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

Medicare 52

Medicare Medicare COVID-19 Hospitals 52

Healthcare IT Today

MAY 16, 2024

Founded in 2018, Myndshft is the only unified platform that streamlines prior authorization and related services for both medical and pharmacy benefits. We are excited to work within the DrFirst network to ease the administrative burden on healthcare providers and help patients access needed therapies and other services.”

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Medicaid Medicaid Medicare Medicare 99

HIT Consultant

NOVEMBER 2, 2023

This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018. – With rising expenses outpacing reimbursement rates, health systems and physician organizations are increasingly turning to value-based care to avoid layoffs and service cuts. million residents.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

The Health Law Firm

SEPTEMBER 24, 2018

Board Certified by The Florida Bar in Health Law On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. Indest III, J.D., Section 15.5.3 Section 15.5.3 New Language Basics.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

AUGUST 10, 2018

Board Certified by The Florida Bar in Health Law On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment policies, payment rates, and quality provisions for services rendered under the Medicare Physician Fee Schedule (PFS). Indest III, J.D., Background Info.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Innovaare Compliance

JUNE 21, 2023

The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). Part B drugs have had the fastest spending growth for drugs for Medicare. percent annually.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Healthcare Law Blog

NOVEMBER 1, 2022

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). See 42 U.S.C.

Medicare 52

Medicare Medicare COVID-19 Public Health 52

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 52

The Health Law Firm

NOVEMBER 28, 2018

Board Certified by The Florida Bar in Health Law On November 2, 2018, a federal judge in Washington, D.C. said the US Department of Health and Human Services (HHS) has until the end of 2022 to completely clear out its backlog of thousands of Medicare billing appeals. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Hospitals 40

HIT Consultant

APRIL 3, 2023

Progress toward VBC adoption hasn’t achieved its potential yet, hovering around 60% of all payment models from 2018 to 2021, with the remaining 40% comprised of traditional fee for service (FFS). Fortunately, healthcare organizations can implement VBA without embarking on a costly rip-and-replace strategy.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. two whistleblowers were the doctor’s former?medical

Fraud 59

Fraud Doctors Elder Abuse Medicare 59

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). 2018), rev’d in part on other grounds sub nom. UnitedHealthcare challenged the current Overpayment Rule in litigation. [1]

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Healthcare IT Today

DECEMBER 13, 2022

UpStream Healthcare (UpStream) , a leading value-based primary care services and technology company, today announced a $140 million Series B funding, bringing its total funding to nearly $185 million to date. We’re excited to deepen our commitment to the company as they expand to make their services available to physicians nationwide.”

Medicare 88

Medicare Medicare Nurses 88

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

C&M Health Law

APRIL 7, 2022

was preempted under ERISA and Medicare Part D. PCMA asserted that Medicare Part D preempted most of the same provisions, as well as a provision that prohibited charging pharmacies a service fee. The scope of Medicare Part D preemption was an issue of first impression in the Tenth Circuit. 36, § 6958, et seq. ,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

FEBRUARY 14, 2023

Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs. Extrapolation For audits for payment year 2018 forward, CMS will implement extrapolation of audit findings against the MAOs plan’s entire audit population to derive the overpayment amount.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Healthcare IT News - Telehealth

OCTOBER 19, 2020

In the suit, the EHR giant argues that it has used the CarePort trademark since 2013 and that in 2018 the telemedicine company changed its name from ER at Home to CarePortMD. In 2018, CarePort Health took over management of AllScripts' Care Management technology to aid with acute-case management and post-acute referrals.

Telemedicine 118

Telemedicine Medicaid Medicaid Hospitals 118

Health Populi

APRIL 8, 2019

As if that top-line number isn’t enough to sober one up, there are two more caveats: (1) the $285K figure doesn’t include long-term care, dental services and over-the-counter medicines; and, (2) it’s an after-tax number. And, it bears repeating, that no long-term care costs are added into this number. “Be Well.

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108

Hall Render

JULY 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. CMS has proposed that 340B hospitals will receive a one-time lump sum payment at the end of 2023 or beginning of 2024.

Hospitals 40

Hospitals Medicaid Medicaid Medicare 40

Healthcare Law Blog

JANUARY 26, 2023

Department of Health and Human Services (“HHS”) published a notice of proposed rulemaking entitled “Safeguarding the Rights of Conscience as Protected by Federal Statutes” (the “ Proposed Rule “). Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. On January 5, 2023, the U.S.

ACA 105

ACA Medicaid Medicaid Compliance 105

CMS.gov

OCTOBER 2, 2018

Modernizing Medicare to Take Advantage of the Latest Technologies. Tue, 10/02/2018 - 13:57. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Jeremy.Booth@c…. Seema Verma. Healthcare is taking up an increasing share of the U.S.

Medicare 44

Medicare Medicare Payment Systems FDA 44

Healthcare IT News - Telehealth

MAY 13, 2020

Although research supported the efficacy of video telepsychiatry, the National Institute of Mental Health-funded study notes, only 5% of psychiatrists in the Medicare program had ever provided a telemedicine visit. The shift to telemedicine was made simpler, researchers note, by regulatory and reimbursement changes.

Telemedicine 215

Telemedicine COVID-19 HIPAA Medicare 215

Healthcare Compliance Blog

JANUARY 14, 2022

million to settle allegations that the company sold custom fabricated shoe inserts to Medicare recipients that did not meet Medicare standards. Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. Department of Health and Human Services, Office of Inspector General (HHS-OIG).

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Health Care Law Brief

JUNE 26, 2022

Under the traditional, or fee-for-service (FFS), Medicare program, CMS directly pays providers a predetermined rate for the items and services furnished to patients under Medicare Parts A and B. In turn, an MA plan pays providers a negotiated rate for the items and services they render to enrollees.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52