Court to Hear RAC Audit Suit
A federal appeals court has overturned a lower court decision and ordered that court to consider a lawsuit against the U.S. Department of Health and Human Services over its nearly two-year backlog in hearing appeals of Medicare Recovery Audit Contractor [...]
President Proposes FY 2017 Budget
That budget proposal calls for numerous cuts in Medicare payments to hospitals, including significant reductions in Medicare bad debt reimbursement, medical education payments, and payments for inpatient rehabilitation services. It also calls for restoring the Medicaid primary care payment increase [...]
Congress Open to Revisiting Medicare Site-Neutral Outpatient Payments?
Conceding that Congress “…has received a large amount of feedback” since including in a 2015 law a provision that compels Medicare to pay for outpatient care on a site-neutral basis, the House Energy and Commerce Committee and its Health Subcommittee [...]
MACPAC: Medicaid DSH Payments Not Always Reaching Targeted Providers
In many cases, Medicaid disproportionate share payments (Medicaid DSH) are being made to hospitals that do not necessarily serve especially large proportions of Medicaid and other low-income patients. So concludes a new report from The Medicaid and CHIP Payment and [...]
CMS Proposes Changes in Medicare ACO Benchmarking
The Centers for Medicare & Medicaid Services has proposed a major change in how performance benchmarking is done for participants in its Medicare shared savings program. According to a CMS news release announcing the newly proposed regulation that includes this [...]
New Medicaid Regulation Clarifies Access to Home Health Services
Under a new regulation unveiled by the Centers for Medicare & Medicaid Services, physicians and other authorized providers now must document their face-to-face encounters with patients when they are authorizing home health services but those encounters can be conducted through [...]
Feds Issue Guidance on Reducing Medicare Readmissions
The Centers for Medicare & Medicaid Services has issued a new report advising hospitals how to reduce readmissions among their racially and ethnically diverse Medicare patients. According to a CMS news release, the guidance …is designed to assist hospital leaders [...]
Challenges In Determining Effectiveness of Dual-Eligible Programs
The federal government is encountering challenges in evaluating the effectiveness of programs designed to serve low-income elderly patients served by both Medicare and Medicaid – patients known as dual-eligibles. Or so concludes the U.S. Government Accountability Office in a new [...]
Report on Social Risk Factors in Medicare Payments
As Medicare continues to move toward making provider payments based on patient outcomes rather than services provided, the National Academies of Sciences, Engineering, and Medicine has issued a new report on the potential impact of socio-economic factors on those patient [...]
New Medicaid Enrollees Cost Less to Serve
Contrary to fears that the long-time uninsured who became eligible for Medicaid under Affordable Care Act eligibility expansion would turn to providers with a long litany of expensive-to-treat medical problems, preliminary data suggests that such individuals are actually less costly [...]
