States Using Medicaid Expansion to Pursue Innovation
While many of the states that have chosen to expand their Medicaid programs under the terms of the Affordable Care Act did so by embracing those terms, others are viewing Medicaid expansion as an opportunity to pursue wholesale changes in [...]
CMS Offers Advice on Managing Expected Upsurge in ER Visits
With Medicaid enrollment rising because of eligibility changes introduced through the Affordable Care Act, hospital emergency rooms expect to see an increase in the number of emergency room visits as new Medicaid enrollees seek care for long-neglected health problems. In [...]
MedPAC Endorses Site-Neutral Payments
MedPAC has recommended to Congress that Medicare equalize the rates paid to hospital outpatient departments and private physicians’ offices for many outpatient services. Currently, hospital outpatient departments are paid more than physician offices for many Medicare-covered services. MedPAC, which advises [...]
MedPAC Recommends Raise for Hospitals
The independent agency that advises Congress on Medicare payment issues has recommended a 3.25 percent increase in Medicare payments to hospitals for inpatient and outpatient services in FY 2015. The Medicare Payment Advisory Commission (MedPAC) also recommended an increase of [...]
Medicare Appeals Go on Back Burner
Faced with a backlog of more than 350,000 appeals of claims decisions, Medicare has announced that that it will suspend acting on new requests for appeals hearings made by hospitals, doctors, nursing homes, and other providers for approximately two years. [...]
Retail Recruiting During Wholesale Times
While most observers keep an eye on state-wide and national health insurance enrollment figures in search of leaps in the tens and even hundreds of thousands of people, the process of enrolling low-income adults in state Medicaid programs for which [...]
The Time May Have Arrived for a Permanent “Doc Fix”
Congress appears serious about addressing a long-running problem: the need for an annual “Medicare doc fix” to address the problem stemming from the use of the sustainable growth rate formula, or SGR, to determine Medicare payments for physician services. For [...]
Safety-Net Hospitals Hurt More by Readmissions Reduction Program
Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study. According to the study, Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have [...]
Medical Homes Model Showing Potential
The “medical homes” model for providing health care is showing promise as a way of reducing the cost of care, reducing utilization of unnecessary medical services, improving access to care, and improving population health. These are among the findings in [...]
Providers Receive Expanded Authority to Extend Presumptive Medicaid Eligibility
While hospitals and providers in 33 states have long enjoyed the ability to extend presumptive eligibility for Medicaid to children or pregnant women, that authority is now being extended in some states to any adults whose income appears likely to [...]
