Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Expanded Telehealth Services One of the most notable changes in Medicare/Medicaid billing for behavioral health is the expanded coverage for telehealth services. All rights reserved.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Fierce Healthcare

JULY 24, 2024

Headway will use the fresh capital to accelerate its planned expansion to Medicare Advantage and Medicaid, CEO Andrew Adams said. New York City-based Headway built a platform to make it both easier for patients to find a therapist and easier for therapists to accept insurance.

Medicaid 85

Medicaid Medicaid Medicare Medicare 85

Fierce Healthcare

AUGUST 9, 2024

Medicare Advantage and Medicaid woes continued to plague some major payers in the second quarter, with UnitedHealth Group regaining its crown as the most profitable company in the industry for Q2.<

Medicaid 122

Medicaid Medicaid Medicare Medicare 122

Fierce Healthcare

SEPTEMBER 6, 2024

In its comments to the Centers for Medicare and Medicaid Services (CMS) on the draft CY2025 Medicare physician fee schedule (PFS), the American Medical Association badgered CMS on its pro | The American Medical Association submitted its comment letter to CMS on its draft CY2025 Medicare physician fee schedule.

Medicare 132

Medicare Medicare Doctors Medicaid 132

Bill of Health

JANUARY 26, 2022

As a first step to protecting incarcerated individuals’ right to health, Congress should repeal the Medicaid Inmate Exclusion Policy (MIEP). The MIEP, established in 1965, prohibits Medicaid from covering incarcerated individuals, despite any prior eligibility. Specifically, states that have expanded Medicaid could save $4.7

Medicaid 299

Medicaid Medicaid COVID-19 Public Health 299

Fierce Healthcare

JUNE 29, 2023

Medicare Advantage (MA) beneficiaries have less choice when it comes to finding a psychiatrist than Medicaid enrollees or those who buy coverage on the Affordable Care Act (ACA) marketplace do, acc | Medicare Advantage continues to grow, and so does the need for beneficiaries to have access to psychiatrists, says a study in Health Affairs.

ACA 110

ACA Medicaid Medicaid Medicare 110

Fierce Healthcare

APRIL 22, 2024

The Centers for Medicare & Medicaid Services is hoping to improve Medicaid enrollees’ access to care through a final rule that better compensates caregiving roles. | CMS released a series of final rules Monday, including Medicaid access regulations that some groups worry will cause providers to close.

Medicaid 128

Medicaid Medicaid Medicare Medicare 128

Healthcare Dive

SEPTEMBER 16, 2024

The Illinois-based pharmacy giant has agreed to pay almost $107 million to settle claims it billed Medicare, Medicaid and other government programs for prescriptions that were never dispensed.

Medicaid 306

Medicaid Medicaid Medicare Medicare 306

Fierce Healthcare

JUNE 13, 2024

The Centers for Medicare & Medicaid Services (CMS) appears poised to rework Medicare Advantage (MA) quality ratings for this year, The Wall Street Journal

Medicare 128

Medicare Medicare Medicaid Medicaid 128

Healthcare Dive

SEPTEMBER 11, 2024

Though CVS Caremark holds a dominant share of the commercial, Medicare Part D and Medicaid managed care markets, each large pharmacy benefit manager seems to be focusing on one particular arena.

Medicaid 317

Medicaid Medicaid Medicare Medicare 317

Healthcare Dive

JULY 10, 2024

The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards in a bid to improve maternal mortality.

Hospitals 288

Hospitals Medicare Medicare Medicaid 288

Fierce Healthcare

MARCH 29, 2024

Virtual mental health company Brightside Health picked up $33 million in fresh funding to help propel its expansion into Medicare and Medicaid populations. | Virtual mental health company Brightside Health picked up $33 million in fresh funding to help propel its expansion into Medicare and Medicaid populations.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Fierce Healthcare

JULY 11, 2024

A recent lawsuit has pushed back against an industry-opposed Centers for Medicare & Medicaid Services (CMS) final rule on broker compensation in Medicare Advantage (MA) plans. | A district court in Texas is halting a federal rule that changes broker compensation and overhauls marketing to seniors.

Medicare 124

Medicare Medicare Medicaid Medicaid 124

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

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Healthcare Dive

DECEMBER 20, 2022

Lawmakers are rushing to speed passage of the $1.7 trillion omnibus spending package as they near a Friday deadline for government funding.

Medicaid 334

Medicaid Medicaid Medicare Medicare 334

HIT Consultant

FEBRUARY 21, 2024

What You Should Know: Brightside Health today announced new and expanded payer partnerships to support Medicaid and Medicare. Recent Developments in Healthcare Contracts and Mental Health Statistics Today’s updates encompass the following developments: – CareOregon: Secures a new contract to cater to Medicaid beneficiaries.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Healthcare Dive

AUGUST 23, 2023

Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicare coverage without proper notice.

Medicaid 246

Medicaid Medicaid Medicare Medicare 246

Fierce Healthcare

MARCH 27, 2024

The Centers for Medicare & Medicaid Services (CMS) released a final rule Wednesday to help individuals obtain and retain Children's Health Insurance Program (CHIP) coverage. | In a final rule set to take effect in two months, CMS is streamlining its Medicaid and CHIP eligibility, enrollment and renewal processes.

Medicaid 111

Medicaid Medicaid Health Insurance Medicare 111

Fierce Healthcare

JANUARY 25, 2024

The Centers for Medicare & Medicaid Services is seeking feedback on how to increase transparency around Medicare Advantage and improve data capabilities. |

Medicare 131

Medicare Medicare Medicaid Medicaid 131

Fierce Healthcare

JUNE 4, 2024

SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services (CMS) inappropriately calculated its star ratings for the 2024 plan | SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services inappropriately calculated (..)

Medicare 119

Medicare Medicare Medicaid Medicaid 119

Healthcare It News

APRIL 15, 2022

Postal Service and an online account this summer to connect with Medicaid enrollees about the expected end of the covid public health emergency, which will put many recipients at risk of losing their coverage. State Medicaid agencies for months have been preparing for the end of the public health emergency.

Medicaid 251

Medicaid Medicaid US Department of Health and Human Services COVID-19 251

Fierce Healthcare

APRIL 5, 2024

Centers for Medicare & Medicaid Services finalized a host of actions ranging from broker compensation, health equity, mental health, supplemental benefits and biosimiliars, in the Contract Year | Medicare Advantage plans will need to adjust to new star ratings requirements, industry watchers warned following a final rule on Thursday.

Medicare 134

Medicare Medicare Medicaid Medicaid 134

Fierce Healthcare

JANUARY 9, 2024

Centers for Medicare & Medicaid Services approved New York's amended Medicaid section 1115 demonstration on Tuesday, spurring the agency to invest in behavioral health and health equity initiat | CMS is helping revamp Medicaid in New York, including more than $3 billion in investments for high-risk social needs services.

Medicaid 103

Medicaid Medicaid Medicare Medicare 103

HIT Consultant

JULY 16, 2024

Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We But there’s a lot of reasons to be optimistic.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

Fierce Healthcare

AUGUST 30, 2023

In a letter sent to all states (PDF), the Centers for Medicare & Medicaid Services ( | As more Medicaid beneficiaries are wrongly kicked off the program, CMS is requiring states to reevaluate its eligibility systems and auto-renewal process.

Medicaid 132

Medicaid Medicaid Medicare Medicare 132

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4 million, and $6.4

Medicaid 83

Medicaid Medicaid Medicare Medicare 83

Fierce Healthcare

NOVEMBER 23, 2022

Google rolls out search features that aim to make it easier to sign up for Medicaid, Medicare. Wed, 11/23/2022 - 11:12.

Medicaid 126

Medicaid Medicaid Medicare Medicare 126

Healthcare IT News - Telehealth

JANUARY 11, 2023

The Kaiser Family Foundation recently looked at state trends with regard to expanding access to telehealth-based behavioral care during the pandemic and found that states see telemedicine as a key component of maintaining access to behavioral healthcare for Medicaid enrollees. WHY IT MATTERS. ON THE RECORD.

Medicaid 160

Medicaid Medicaid Medicare Medicare 160

Healthcare Dive

OCTOBER 1, 2024

Threatened with steep sanctions and loss of its agreement with Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.

Governance 193

Governance Medicaid Medicaid Medicare 193

Fierce Healthcare

FEBRUARY 21, 2024

Medicaid disproportionate share hospital (DSH) payments are being cut by $8 billion annually during the current and next four federal fiscal years under a new Centers for Medicare and Medicaid Serv | Published Tuesday and set to go into effect in two months, the final rule limits the calculation of a hospitals Medicaid shortfall to beneficiaries with (..)

Medicaid 104

Medicaid Medicaid Hospitals Medicare 104

Fierce Healthcare

NOVEMBER 20, 2023

Traditional Medicare paid out an estimated $31.2 The Centers for Medicare & Medicaid Services released its annual look at improper payments and found that the overall rate in Medicare was 7.38%, which sits below the 10% level mandated in statute.

Medicare 131

Medicare Medicare Medicaid Medicaid 131

Fierce Healthcare

DECEMBER 15, 2023

The Centers for Medicare & Medicaid Services is rolling out a new payment model that aims to support state Medicaid agencies in offering whole-person maternal care. |

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

Fierce Healthcare

SEPTEMBER 19, 2023

The Centers for Medicare & Medicaid Services (CMS) finalized a rule Monday to streamline enrollment in Medicare Savings Programs (MSPs) with the aim of making coverage affordable for 860,000 mo | A $26.16 billion CMS rule will streamline Medicare Savings Program enrollment, reducing administrative burden in the process.

Medicare 119

Medicare Medicare Medicaid Medicaid 119

Bill of Health

APRIL 13, 2022

When the PHE ultimately expires, this will also trigger the end of the Medicaid continuous enrollment requirement, under which states must provide continuous Medicaid coverage for enrollees through the end of the last month of the PHE in order to receive enhanced federal funding. Continuity of Coverage.

Medicaid 147

Medicaid Medicaid COVID-19 Public Health 147

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. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. General Legal Duties and Antitrust Laws.

Fraud 59

Fraud Medicaid Medicaid Medicare 59

Fierce Healthcare

SEPTEMBER 14, 2023

A third set of Medicare Part B prescription drugs will cost up to $618 less per average dose beginning Oct. 1, announced the Centers for Medicare & Medicaid Services (CMS). |

Medicare 130

Medicare Medicare Medicaid Medicaid 130