Fierce Healthcare

OCTOBER 19, 2023

billion in savings across 20 of Medicare’s most expensive conditions in 2019— tho | Lobbying groups in favor of overturning the ban on new physician-owned hospitals outlined broad cost savings if 2019's Medicare patients were treated at such facilities instead of a traditional hospital.

Hospitals 144

Hospitals Doctors Medicare Medicare 144

HIT Consultant

JANUARY 26, 2023

Mighty Health is the the first all-in-one daily health program designed for adults ages 50 and up—covers more than 9 million Americans nationwide through partnerships with leading Medicare Advantage and commercial health plans. The app has supported more than 200,000 individuals to date, with exciting plans for expansion and new offerings.

Medicare 85

Medicare Medicare Doctors 85

Electronic Health Reporter

APRIL 8, 2019

On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefit (Part D) programs by promoting innovative plan designs, improved quality, and choices for patients. Illegal copying is prohibited.

Medicare 89

Medicare Medicare Medicaid Medicaid 89

Hall Render

JUNE 8, 2023

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

Medicare 40

Medicare Medicare Hospitals Governance 40

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

Health Populi

APRIL 8, 2019

The average 65-year old couple retiring in 2019 will need to have a cash nest-egg of $285,000 to cover health care and medical expenses through retirement years, Fidelity Investments calculated. That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement.

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Electronic Health Reporter

APRIL 7, 2020

The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided […].

Medicare 79

Medicare Medicare COVID-19 Medicaid 79

Bill of Health

MAY 22, 2023

The selections feature topics ranging from an analysis of government and industry investments for recently approved drugs, to a discussion of court decisions on mifepristone, and an examination of the added therapeutic benefit associated with the top-selling brand-name drugs in Medicare. Galkina Cleary E, Jackson MJ, Zhou EW, Ledley FD.

Pharmaceutical Industry 157

Pharmaceutical Industry Medicare Medicare Medicaid 157

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

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. Between 2017 and 2019, the Missouri woman owned and managed several durable medical equipment (DME) companies. General Legal Duties and Antitrust Laws.

Fraud 59

Fraud Medicaid Medicaid Medicare 59

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 52

Hall Render

JULY 18, 2022

The Centers for Medicare & Medicaid Services (“CMS”) has given itself an extra year to review and assess skilled nursing facility proposed regulations issued in 2019. Areas Addressed in 2019 Proposed Rule. Background. Extra Time. The notice extends the timeline to finalize the provisions until July 18, 2023.

Nurses 40

Nurses COVID-19 Compliance Medicare 40

Mobi Health News

JULY 12, 2018

The Centers for Medicare and Medicaid Services released its new proposed Physician Fee Schedule and Qualified Payment Program updates for 2019, and the announcement includes some big strides forward in promoting digital health technology, including widened telemedicine coverage, an overhaul of documentation requirements, and a new focus on interoperability. (..)

Telemedicine 67

Telemedicine Medicaid Medicaid Medicare 67

Health Populi

AUGUST 21, 2019

There are over 60 million enrollees in Medicare in 2019, and fully one-third are in Medicare Advantage plans. Medicare is adding 10,000 new beneficiaries every day in the U.S. Medicare Advantage enrollment is fast-growing, shown in the first chart where over 22 million people were in MA plans in January 2019.

Medicare 81

Medicare Medicare Health Outcomes HIPAA 81

HIT Consultant

DECEMBER 20, 2021

What You Should Know: – Medicare Advantage provider Zing Health raises $25M from Town Hall Ventures and Leavitt Equity Partners, two leading investors focused on growing innovative healthcare businesses.

Medicare 52

Medicare Medicare 52

HIPAA Journal

SEPTEMBER 29, 2022

The Government Accountability Office (GAO) recently conducted a review of Medicare telehealth services provided during the COVID-19 pandemic, when a waiver was in place that greatly expanded access to telehealth and virtual visits. Between April and December 2019, 5 million Medicare telehealth visits were conducted.

Medicare 70

Medicare Medicare COVID-19 HIPAA 70

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

Medicare 52

Medicare Medicare Overpayments Overpayment 52

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 Populi

OCTOBER 17, 2019

In 2019, it appears that patients have backslid, according to the 2019 Healthcare Consumerism Index from Alegeus. adults in September 2019 on issues concerning health care costs, shopping, value, saving and spending. The first chart shows that the 2019 Index fell from 60.1 points in 2018 to 57.9 households.

Health Insurance 58

Health Insurance Medicare Medicare Governance 58

Health Populi

APRIL 14, 2019

The post Health/Care Everywhere – Re-Imagining Healthcare at ATA 2019 appeared first on HealthPopuli.com. The barriers to adopting virtual, digital, telehealth modes have been regulatory, financial, and cultural — not so much technical.

Telemedicine 91

Telemedicine Hospitals Medicare Medicare 91

Health Populi

JUNE 24, 2019

Cost is the major reason why Medicare Advantage plan beneficiaries switch plans, but people who switch also tend to have lower satisfaction scores based on non-cost factors. Power’s 2019 Medicare Advantage Plan Study. Power surveyed 3,233 members of Medicare Advantage plans in January through March 2019.

Medicare 56

Medicare Medicare Health Insurance 56

Healthcare Law Today

JANUARY 20, 2022

The Centers for Medicare & Medicaid Services (CMS) has responded to these calls by continuing its efforts to address this epidemic and expand access to mental/behavioral health in its new 2022 Physician Fee Schedule Final Rule. The New Rule and the SUPPORT Act. geographic location, originating site, etc.). What’s next?

Medicare 52

Medicare Medicare COVID-19 Public Health 52

The Health Law Firm

OCTOBER 31, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. By George F. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare Doctors 40

Hall Render

FEBRUARY 15, 2022

In December 2021, the Office of Inspector General (“OIG”) of the Department of Health and Human Services published an Issue Brief titled “Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than Wholly Owned Settings” (“Brief”)(available here ). Issue Brief Findings.

Medicare 40

Medicare Medicare Hospitals Compliance 40

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

The Health Law Firm

DECEMBER 30, 2019

Board Certified by The Florida Bar in Health Law For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

Healthcare Law Today

NOVEMBER 9, 2022

Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” Background and History of Medicare Telehealth Coverage of SUD Treatment. New Changes to Medicare OTP Telehealth Services.

Medicare 52

Medicare Medicare COVID-19 Telemedicine 52

Healthcare IT News - Telehealth

APRIL 21, 2022

According to a press release , the surgeon, 56-year-old Dr. Elemer Raffai, is accused of allegedly submitting false claims to Medicare in exchange for kickbacks from telemedicine companies. Raffai, together with others, is allegedly connected to the submission of approximately $10 million in fraudulent claims to Medicare.

Fraud 170

Fraud Telemedicine Medicare Medicare 170

Healthcare It News

NOVEMBER 23, 2023

It has been working with HSS on the digital transformation of WA Health since 2019. MyMedicare is a voluntary patient registration model launched by the Australian government as part of broader efforts to strengthen the Medicare insurance scheme.

Public Health 259

Public Health Governance Hospitals Medicare 259

HIT Consultant

OCTOBER 27, 2023

In 2019, there was a net loss of 10 clinicians per 100,000 people across the United States. In 2022, MSSP saved Medicare $1.8 residents currently do not have a relationship with a primary care clinician, and 40% of adults in the United States failed to have a primary care visit in 2019. in 2013 to 4.6%

COVID-19 98

COVID-19 Medicare Medicare Hospitals 98

Healthcare IT News - Telehealth

JULY 22, 2022

Meanwhile, the Centers for Medicare and Medicaid Services' Center for Program Integrity also announced that it has taken administrative actions against more than 50 healthcare providers alleged to be involved in similar schemes. billion in alleged fraud. healthcare system at the expense of patients."

Fraud 136

Fraud Telemedicine Medicare Medicare 136

Healthcare IT News - Telehealth

MARCH 25, 2021

Using data from Blue Health Intelligence data repository – an independent data and analytics company that is a licensee of the Blue Cross and Blue Shield Association – researchers from the Johns Hopkins Bloomberg School of Public Health compared claims data from March through June 2019 with March through June 2020.

COVID-19 203

COVID-19 Public Health Medicare Medicare 203

The Health Law Firm

OCTOBER 3, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. By George F. Indest III, J.D.,

Fraud 40

Fraud Doctors Medicare Medicare 40

Healthcare IT News - Telehealth

FEBRUARY 22, 2021

Among the allegations are that Wolfe and her conspirators submitted well over $400 million in illegal durable medical equipment claims to Medicare and the Civilian Health and Medical Program of the Department of Veterans, relying on the guise of "telemedicine" to explain the unusually high volume of claims.

Fraud 190

Fraud Telemedicine US Department of Health and Human Services Medicare 190

Electronic Health Reporter

MARCH 6, 2020

The Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19). This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited.

COVID-19 89

COVID-19 Medicaid Medicaid Medicare 89

Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

ACA 105

ACA Medicaid Medicaid Compliance 105