The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated. Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program. MORE
Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. Walmart has been a health/care destination for many years. MORE
Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Financial Medicare and Medicaid Medicaid Medicare payment models Value Based Payments MORE
What ONC is up to — HITAC task force on interoperability to get underway MORE
Q: Per Medicare regulations, do the providers at a distant site have to be hospital-based or can they be in a private setting – for example, a group of pulmonologists who want to create a telehealth system on their own? Also, all telehealth services must meet the Medicare established set of criteria for reimbursement. Click here to visit the Medicare Eligibility Analyzer site. To review CCHP information on Medicare, go to: [link]. Medicare MORE
The Department of Justice has asked Anthem for more information about its Medicare Advantage and Part D plans as part of an ongoing probe dating back to 2016. Anthem says the inquiry is part of an investigation into other Medicare Advantage health plans, as well as providers and vendors MORE
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The president attacked a Medicare-for-all proposal in an opinion column on Wednesday, and the senator who introduced that bill hit back. Plus, a study suggests for-profit nursing homes are sending patients to therapy at the end of their lives to make more money MORE
Responding to a request for information from CMS, the American Hospital Association said it "strongly opposes" revising Medicare Conditions of Participation to include interoperability requirements. The hospital association argued that interoperability is difficult for surveyors to measure and unfairly targets hospitals for data sharing problems that span the healthcare ecosystem MORE
Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. ” Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. MORE
the Helping Expand Access to Rural Telehealth (HEART) Act targets the Center for Medicare & Medicaid Services’ (CMS) strict limitations on RPM reimbursements in rural areas. Of the 107,000 telemedicine visits for Medicare beneficiaries recorded in 2013, approximately 40,000 of them served rural areas. are on Medicaid and/or Medicare. The post HEART Act Targets Medicare Limits on Telehealth appeared first on American Well. MORE
The Centers for Medicare & Medicaid Services (CMS) released the 2018 Physician Fee Schedule about two weeks ago and there is at least one nugget in there that should speed the adoption of remote patient monitoring. MORE
Payers are rapidly becoming educated in telehealth and are keen on closing telehealth gap, but need to be mindful of Medicare requirements. Almost a third of telemedicine claims sampled by HHS’ Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7 MORE
Financial health Health Consumers Health costs Health Economics Health policy Heart health Medicare Medicines Mental health Money and health Obesity Personal health finance Pharmaceutical Prescription drugs Prevention Public health Specialty drugs TransparencyThe U.S. MORE
Modernizing Medicare to Take Advantage of the Latest Technologies. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Today we are announcing a revision of Medicare’s local coverage determination process, which will pave the way to expanded access to new technologies. However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change. MORE
It’s February 1st, which marks the first of 28 days of American Heart Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America. MORE
Medicare Related Topics 
BHM Healthcare Solutions
OCTOBER 2, 2018
Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Financial Medicare and Medicaid Medicaid Medicare payment models Value Based Payments
BHM Healthcare Solutions
JUNE 26, 2018
Editor’s Note: The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3%
The cHealth Blog
NOVEMBER 16, 2017
The Centers for Medicare & Medicaid Services (CMS) released the 2018 Physician Fee Schedule about two weeks ago and there is at least one nugget in there that should speed the adoption of remote patient monitoring.
BHM Healthcare Solutions
AUGUST 7, 2018
Editor’s Note: The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% CMS data showed Medicare spending for hospice care rose 81 percent between 2006 and 2016, from $9.2.
BHM Healthcare Solutions
APRIL 10, 2018
Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Financial Medicare and Medicaid Medicaid Medicare payment models Value Based Payments
BHM Healthcare Solutions
JUNE 5, 2018
Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Total Medicare reimbursement for all brand-name drugs ballooned 77 percent from 2011 to 2015.
BHM Healthcare Solutions
AUGUST 7, 2018
Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. ” Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.
FierceHealthIT
SEPTEMBER 19, 2018
Recovery audit contractors (RACs) returned $214 million to the Medicare program in fiscal year 2016. of Medicare expenditures, and one organization says the program is hampered by limits on documentation requests But that represents less than 0.1%
FierceHealthIT
OCTOBER 1, 2018
will pay $270 million to resolve claims it provided inaccurate information that caused Medicare Advantage plans to receive inflated Medicare payments A medical care group that is part of dialysis giant DaVita Inc.
FierceHealthIT
OCTOBER 10, 2018
Kaiser's Medicare Advantage plans averaged an overall score of 4.8, boosted by four five-star plans. The remaining large insurers received average star ratings in the mid- to high 3s
FierceHealthIT
OCTOBER 3, 2018
Humana's Medicare Advantage HMO base in southern California will be able to spend more time with providers and receive more robust preventive care as a result of a collaboration with Heritage, the insurer said
FierceHealthIT
OCTOBER 2, 2018
Of the nearly $7 billion Medicare paid to inpatient rehab hospitals in 2013, $5.7 billion was deemed improper. The watchdog agency recommended that CMS revamp its payment structure for rehab hospitals
Morning eHealth
APRIL 27, 2018
FDA draws strong, mixed reaction — U.S. Digital Service hands QPP back to CMS
FierceHealthIT
OCTOBER 3, 2018
CMS Administrator Seema Verma took another swipe at calls for a “Medicare for All” healthcare system this week, saying expanding those benefits to every American would “dilute” the program
FierceHealthIT
OCTOBER 8, 2018
Medicaid for all would bring many of the same benefits as Medicare for all without the political barriers, albeit in fewer states
Health Populi
MARCH 27, 2018
The latest data on health care costs in retirement was published by EBRI earlier this year in their report , Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $370,000, Up from $350,000 in 2016.
FierceHealthIT
SEPTEMBER 27, 2018
The HHS Office of Inspector General recommended that CMS become significantly more involved in overseeing Medicare Advantage organizations (MAOs) following a recent report. OIG found that MAOs routinely deny payment for services that should have been provided
FierceHealthIT
SEPTEMBER 21, 2018
Kaiser and Aetna received high marks for their Medicare plans thanks to an emphasis on prevention. UnitedHealth, Humana and Cigna registered more mediocre ratings
FierceHealthIT
SEPTEMBER 14, 2018
Medicare spends nearly $1,000 less per beneficiary in counties where residents are not only healthy, but happy and satisfied with their lives
BHM Healthcare Solutions
MAY 1, 2018
Payers are rapidly becoming educated in telehealth and are keen on closing telehealth gap, but need to be mindful of Medicare requirements. Almost a third of telemedicine claims sampled by HHS’ Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7
Morning eHealth
JULY 16, 2018
What ONC is up to — HITAC task force on interoperability to get underway
FierceHealthIT
SEPTEMBER 11, 2018
The Centers for Medicare & Medicaid Services asked for comments on its proposed physician fee schedule and boy, oh boy, did it get them: 15,314 of them
Health Populi
JUNE 7, 2018
Financial health Health Consumers Health costs Health Economics Health policy Heart health Medicare Medicines Mental health Money and health Obesity Personal health finance Pharmaceutical Prescription drugs Prevention Public health Specialty drugs TransparencyThe U.S.
FierceHealthIT
OCTOBER 10, 2018
The president attacked a Medicare-for-all proposal in an opinion column on Wednesday, and the senator who introduced that bill hit back. Plus, a study suggests for-profit nursing homes are sending patients to therapy at the end of their lives to make more money
FierceHealthIT
AUGUST 30, 2018
New data released by CMS shows ACOs cut Medicare costs by hundreds of millions of dollars after accounting for shared savings payments. The National Association of ACOs said the data proves Track 1 ACOs are generating savings
FierceHealthIT
SEPTEMBER 28, 2018
Medicare Advantage premiums continue to decrease and will reach a three-year low average of $28 in 2019, according to the Centers for Medicare & Medicaid Services. About 46% of enrollees will have zero premium
FierceHealthIT
SEPTEMBER 4, 2018
UnitedHealth's chief pharmacy officer told FierceHealthcare that CMS' new guidance around step therapy will generate "significant" savings for Medicare Advantage beneficiaries. But AMA said it will lead to "unnecessary red tape" and more denials for patients
FierceHealthIT
AUGUST 9, 2018
Much of the House Republican conference is having second thoughts about closing a doughnut hole for Medicare Part D enrollees, inspiring the AARP to weigh in
American Well Blog
JUNE 25, 2017
the Helping Expand Access to Rural Telehealth (HEART) Act targets the Center for Medicare & Medicaid Services’ (CMS) strict limitations on RPM reimbursements in rural areas. Of the 107,000 telemedicine visits for Medicare beneficiaries recorded in 2013, approximately 40,000 of them served rural areas. are on Medicaid and/or Medicare. The post HEART Act Targets Medicare Limits on Telehealth appeared first on American Well.
FierceHealthIT
APRIL 12, 2018
Medicare Advantage plans have been touted as a way to give more control to seniors, but non-minorities may be reaping most of the benefits. A new report finds that minorities enrolled in MA plans are receiving worse clinical care than white patients, following similar studies
Mobi Health News
AUGUST 15, 2018
Oscar says it uses technology to lower cost: More than 60 percent of member interactions with health systems are virtual
FierceHealthIT
JUNE 25, 2018
Responding to a request for information from CMS, the American Hospital Association said it "strongly opposes" revising Medicare Conditions of Participation to include interoperability requirements. The hospital association argued that interoperability is difficult for surveyors to measure and unfairly targets hospitals for data sharing problems that span the healthcare ecosystem
FierceHealthIT
SEPTEMBER 17, 2018
CMS took the latest step in its Patients over Paperwork initiative on Monday, issuing a proposed rule that would eliminate or update a slew of regulations deemed “unnecessary, obsolete or excessively burdensome” on providers.
ConnectedHealth
MARCH 17, 2017
The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated. Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program.
The CMS Blog
OCTOBER 2, 2018
Modernizing Medicare to Take Advantage of the Latest Technologies. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Today we are announcing a revision of Medicare’s local coverage determination process, which will pave the way to expanded access to new technologies. However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change.
FierceHealthIT
MARCH 26, 2018
Despite concerns from industry analysts, Medicare Advantage plans are thriving in the wake of the ACA; a new Kaiser Family Foundation poll suggests support for a "Medicare for all" program is on the rise; plus more health insurance headlines
FierceHealthIT
MAY 29, 2018
The Centers for Medicare & Medicaid Services heard both pros and cons on its proposal to allow physicians to bill Medicare patients directly
Health Populi
JANUARY 31, 2018
It’s February 1st, which marks the first of 28 days of American Heart Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America.
FierceHealthIT
MAY 11, 2018
The Trump administration has its sights on major changes to Medicare in its quest for lower drug prices, with proposed changes to Part D formularies and increased scrutiny of PBM rebates
Health Populi
APRIL 16, 2018
Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. Walmart has been a health/care destination for many years.
FierceHealthIT
JULY 12, 2018
A new analysis from Avalere shows Medicare Advantage patients have fewer inpatient stays, ER visits and avoidable hospitalizations than fee-for-service beneficiaries, despite higher rates of social and economic risk factors
FierceHealthIT
SEPTEMBER 5, 2018
While physician group ACOs saved Medicare millions, hospital-integrated ACOs cost the program even more than usual, the Harvard-based researchers found
FierceHealthIT
APRIL 26, 2018
The Department of Justice has asked Anthem for more information about its Medicare Advantage and Part D plans as part of an ongoing probe dating back to 2016. Anthem says the inquiry is part of an investigation into other Medicare Advantage health plans, as well as providers and vendors
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