Healthcare Dive

MAY 30, 2024

Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.

Medicaid 244

Medicaid Medicaid Medicare Medicare 244

Medisys Compliance

JANUARY 29, 2025

Add in the complexities of Medicare and Medicaid, and it can feel overwhelming. This article will explore how outsourcing cardiology billing for Medicare and Medicaid can streamline your operations, boost revenue, and free you to focus on delivering exceptional cardiac care.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Medisys Compliance

JUNE 8, 2025

When a healthcare provider treats a patient who has Medicare as well as another type of health insurance, understanding the rules for Medicare Coordination of Benefits (COB) becomes essential. What is Medicare Coordination of Benefits? Medicare is primary if the employer has fewer than 20 employees.

Medicare 66

Medicare Medicare ACA Medical Billing Outsourcing 66

NEJM

MAY 28, 2025

Dual-eligible Medicare–Medicaid beneficiaries receive the Low-Income Subsidy, which reduces cost sharing for medications. Loss of drug subsidies after Medicaid disenrollment was associated with increased mortality.

Medicare 75

Medicare Medicare Medicaid Medicaid 75

HIT Consultant

MARCH 11, 2025

– The solution aims to help Medicare Advantage plans improve their TRC Star measure performance by automating the access and delivery of critical admission and discharge information. The new solution addresses the significant issue of hospital readmissions among Medicare beneficiaries. billion annually.

Medicare 99

Medicare Medicare Medicaid Medicaid 99

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 258

Medicaid Medicaid US Department of Health and Human Services COVID-19 258

HealthIT Answers

APRIL 3, 2025

By Lauren Barca, MHA, RN - The headlines for 2025 Medicare, Medicaid, and dual-eligible programs are rife with concerns about proposed changes. While those worries were certainly a topic of discussion at AHIPs recent Medicare, Medicaid, Duals, and Commercial Markets Forum in Baltimore, Maryland, they werent the only story.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Healthcare It News

MARCH 30, 2022

Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic. "Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report.

Medicare 286

Medicare Medicare US Department of Health and Human Services COVID-19 286

Healthcare It News

NOVEMBER 8, 2024

As of January 1, the Centers for Medicare and Medicaid Services has mandated that healthcare organizations screen for five social risk drivers. Hatch leads the development of clinical programs and research partnerships. She has also contributed to National Quality Forum efforts to address social determinants of health utilization.

Public Health 278

Public Health Health Analytics Medicaid Medicaid 278

Fierce Healthcare

NOVEMBER 26, 2024

The Centers for Medicare & Medicaid Services (CMS) is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov.

Medicaid 128

Medicaid Medicaid Medicare Medicare 128

Healthcare Dive

FEBRUARY 13, 2025

House Republicans unveiled their budget wish list on Wednesday, which directs the Energy and Commerce Committee — which oversees Medicare and Medicaid — to find $880 billion in savings.

Medicaid 363

Medicaid Medicaid Medicare Medicare 363

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 282

Hospitals Medicare Medicare Medicaid 282

Healthcare IT News - Telehealth

FEBRUARY 22, 2024

Brightside Health will be entering into new and expanded payer partnerships to support telemental healthcare access through Medicare and Medicaid, teaming with companies such as Blue Shield of California, CareOregon and Centene.

Medicaid 149

Medicaid Medicaid Medicare Medicare 149

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

HIT Consultant

DECEMBER 23, 2024

Brian Norris, Managing Director of Strategic Consulting at MedeAnalytics There are almost 33 million people enrolled in eligible Medicare programs. Nearly half are enrolled in Medicare Advantage (MA) plans, and that number is expected to continue its climb.

Health Outcomes 97

Health Outcomes Medicare Medicare Patient Satisfaction 97

Healthcare IT Today

APRIL 4, 2025

Translation of member materials is an onerous burden for Medicare Advantage Organizations (MAOs). For Dual Special Needs Plans (DSNPs), compliance is even more complex as they must meet both Medicare and Medicaid translation requirements, supporting as many as 24 languages in some states.

Medicare 84

Medicare Medicare Medicaid Medicaid 84

Fierce Healthcare

SEPTEMBER 27, 2024

Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries of | A new report from HHS OIG looked at access to medication for opioid use disorder services and found many high need counties do not have specialized providers. (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

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 313

Medicaid Medicaid Medicare Medicare 313

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 301

Medicaid Medicaid Medicare Medicare 301

MRO Compliance

FEBRUARY 26, 2025

Likewise, payers are mandated by the Centers for Medicare & Medicaid Services to make member data available to external stakeholders via application program interfaces. Clinical data is a two-way street for payers. These organizations require timely and accurate patient data from their healthcare provider partners.

Medicaid 147

Medicaid Medicaid Medicare Medicare 147

Healthcare Dive

APRIL 19, 2023

The payer said it was pleased with the recent CMS decision to phase in risk adjustment changes to the Medicare Advantage program that would allow it to “smooth the impact” to beneficiaries and providers.

Medicaid 246

Medicaid Medicaid Medicare Medicare 246

Medisys Compliance

MARCH 9, 2025

Understanding Medicare coverage for counseling can feel particularly challenging, but it is crucial. Many providers find themselves asking: What exactly does Medicare cover when it comes to outpatient mental health counseling services? This cornerstone of outpatient mental health care is generally well-covered by Medicare.

Medicare 59

Medicare Medicare Medical Billing Medical Billing Services 59

MRO Compliance

JUNE 9, 2025

The Centers for Medicare & Medicaid Services (CMS) has set a bold goal : by 2030, all Medicare beneficiaries and the majority of Medicaid beneficiaries must participate in value-based payment models. This shift represents one of the most ambitious overhauls in U.S.

Overpayments 147

Overpayments Overpayment Compliance Medicaid 147

HIT Consultant

JUNE 3, 2025

. – The company has introduced a new feature allowing caregivers to help manage medications for family members or loved ones, and has expanded access to its PillPack by Amazon Pharmacy service to customers with Medicare insurance.

Medicare 64

Medicare Medicare Health Insurance Medicaid 64

Medisys Compliance

JUNE 3, 2025

Behavioral health providers who serve Medicaid patients often face a uniquely complex billing environment. Understanding Medicaid behavioral health billing guidelines is essential to avoid costly errors and ensure compliance. This article offers a general, non-state-specific guide to Medicaid behavioral health billing.

Medicaid 59

Medicaid Medicaid Medical Billing Outsourcing Compliance 59

Fierce Healthcare

NOVEMBER 3, 2024

Under a final rule issued by the Centers for Medicare and Medicaid Services, outpatient hospital facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from | Under a final rule issued by CMS, outpatient hospital facilities and ambulatory surgical centers will get a 2.9%

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Healthcare Dive

SEPTEMBER 29, 2023

The Congressional Budget Office report estimated the Center for Medicare and Medicaid Innovation, which was created in part to reduce spending, will increase net federal spending by $1.3 billion from 2021 through 2030.

Medicaid 307

Medicaid Medicaid Medicare Medicare 307

MRO Compliance

MAY 15, 2025

Overview of Major Health Plan Types Medicare: A federal program for individuals 65+ or those under 65 with disabilities, offering coverage for facility, outpatient, and prescription drug services. Medicare and Medicaid can work together for dual-eligible beneficiaries, offering comprehensive support.

Electronic Medical Records 147

Electronic Medical Records Medicaid Medicaid ACA 147

HIT Consultant

APRIL 22, 2025

Lucienne Ide, MD, PhD, Founder and CEO of Rimidi The promise of remote patient monitoring (RPM) to revolutionize healthcare delivery remains just out of reach for millions of Americans, namely the people who stand to gain the most from it Medicaid recipients facing significant health disparities.

Medicaid 88

Medicaid Medicaid Medicare Medicare 88

Healthcare Dive

DECEMBER 15, 2022

Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.

Medicaid 293

Medicaid Medicaid Medicare Medicare 293

Fierce Healthcare

AUGUST 15, 2024

The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations. | The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations.

Medicare 135

Medicare Medicare Medicaid Medicaid 135

Healthcare Dive

APRIL 21, 2025

During a ceremony at the Oval Office, Dr. Mehmet Oz said he would focus on reducing chronic disease, “modernizing” Medicare and Medicaid, and targeting fraud, waste and abuse in government insurance offerings.

Fraud 251

Fraud Medicaid Medicaid Medicare 251

Healthcare Dive

NOVEMBER 8, 2023

Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s. Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics?

Health Insurance 270

Health Insurance Medicaid Medicaid Medicare 270

Healthcare IT News - Telehealth

JUNE 3, 2025

"State medical boards, the Centers for Medicare & Medicaid Services, and commercial payers all are stepping up enforcement around where and how care is delivered.

Telemedicine 159

Telemedicine Licensing Compliance Medicaid 159

Fierce Healthcare

OCTOBER 29, 2024

Accountable care organizations saved Medicare $2.1 billion, the largest yearly savings in program history, in 2023, the Centers for Medicare & Medicaid Services revealed on Tuesday. Accountable care organizations (ACOs) saved Medicare $2.1

Medicare 131

Medicare Medicare Medicaid Medicaid 131

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. |

Medicare 132

Medicare Medicare Doctors Medicaid 132

Bill of Health

NOVEMBER 12, 2024

Policy Solution #1: State Medicaid Expansion Expanding Medicaid in Alabama could bolster the finances of rural hospitals, which currently bear the substantial costs of uncompensated care for uninsured patients. However, Alabama’s political leadership remains resistant to Medicaid expansion. Senator Katie Britt (R-AL).

Medicaid 113

Medicaid Medicaid Hospitals Health Outcomes 113