Medicare Hospice Program Vulnerable According to Inspector General Report

BHM Healthcare Solutions

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.

Study: More Medicare Patients Dying At Home

BHM Healthcare Solutions

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%

Medicare Drug Prices Up Despite Decrease in Prescriptions

BHM Healthcare Solutions

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.

Medicare Reimbursement for Remote Monitoring Should Drive Adoption (What a long, strange trip it’s been….)

The cHealth Blog

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.

Medicare Advantage Plans Grow With Star Ratings

BHM Healthcare Solutions

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

CMS telemedicine expansion could lead to cuts in Medicare base rate

Morning eHealth

What ONC is up to — HITAC task force on interoperability to get underway

AARP to GOP: Leave Medicare Part D doughnut hole alone


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

Telehealth Payments Don’t Meet Medicare Requirements

BHM Healthcare Solutions

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

Alphabet's $375M investment in Oscar Health will expand insurer into Medicare Advantage

Mobi Health News

Oscar says it uses technology to lower cost: More than 60 percent of member interactions with health systems are virtual

The Patient As Payor: From Rationing Visits Due to Co-Pays to Facing $370K for Healthcare in Retirement

Health Populi

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.

AHA ‘strongly opposes’ interoperability as a Medicare requirement


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

Racial, ethnic disparities persist in Medicare Advantage


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

HEART Act Targets Medicare Limits on Telehealth

American Well Blog

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.

Technology, Aging and Obesity Drive Healthcare Spending, BEA Finds

Health Populi

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.

Physician groups remain split over CMS proposal to allow direct Medicare billing


The Centers for Medicare & Medicaid Services heard both pros and cons on its proposal to allow physicians to bill Medicare patients directly

Medicare Advantage beats fee-for-service in utilization, outcomes


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

Payer Roundup—Medicare Advantage thriving under ACA; KFF says support for 'Medicare for All' gains steam with voters


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

Trump targets Medicare, PBMs in plan to lower drug prices


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

MACRA: Medicare’s Opportunity to Finally Embrace Connected Health Technology


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.

CMS allows Medicare Advantage plans to negotiate Part B drug prices, implement step therapy


In a significant move meant to foster competition, allowing Medicare Advantage plans to negotiate Part B drug prices will generate cost savings that they then can pass on to consumers, the agency says

What is MIPS? 60% of doctors aren't familiar with Medicare payment system


Most physicians treating Medicare patients don’t know how Medicare is evaluating and paying them, a new study concluded. The survey found that more than 60% of doctors reported little to no familiarity with MIPS

DOJ investigating Anthem’s Medicare Advantage, Part D plans


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

Centene plans Medicare Advantage joint venture with Ascension


The announcement followed two other recent acquisitions by the insurer to boost its MA population, as well as favorable growth in Medicare overall this past quarter

Cerner sinks $266M into Lumeris as part of strategic partnership targeting Medicare Advantage plans


Cerner will become a minority owner in Lumeris' parent company as part of a 10-year strategic partnership focused on value-based care payment arrangements, particularly in the Medicare Advantage space. The two companies plan to release a new joint offering, Maestro Advantage, this year

Aetna rides Medicare Advantage growth, ACA exit to profitable Q1


Aetna has added 250,000 Medicare Advantage members on its way to a profitable first quarter as it looks to close a deal with CVS Health. The insurer reported $1.2 billion in net income thanks, in part, to an ACA exchange exit

CMS' Seema Verma: Medicare data sharing proposal is 'about the patient'


A proposed rule change last month would require hospitals to share data as a requirement of participating in Medicare

How Walmart Could Bolster Healthcare in the Community

Health Populi

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.

Centene CEO hints at Medicare acquisition, touts scalable clinic model


"Until a deal is done, it's not done," Centene CEO Michael Neidorff said during an earnings call Tuesday in response to a question about inorganic Medicare growth. Company executives appeared unfazed about the current risk adjustment freeze and looming competition on the ACA marketplace

DOJ expands Medicare Fraud Strike Force to Newark and Philadelphia


The Justice Department selected the cities for the Strike Force's newest division due to the prominence of fraud, including illegal opioid distribution, in the region

Elderly Medicare patients less likely to have minimally invasive surgeries


A new study from Johns Hopkins University indicates that not enough Medicare patients undergo minimally invasive surgeries, despite better outcomes, fewer readmissions and lower costs. Researchers said that the findings indicate there is an opportunity for Medicare and other payers to spend healthcare dollars more wisely so that they reward high-value care over low-value care

Heart-Love – Omron’s Holy Grail of Blood Pressure Tracking on the Wrist

Health Populi

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.

CMS to release Medicare Advantage encounter data as part of new data-driven strategy


CMS is making good on its promise to release encounter data that it collects from Medicare Advantage plans. The agency was scheduled to release the data last year, but concerns over accuracy caused them to pull back, disappointing researchers. CMS also announced that it will publicly release data for Medicaid and CHIP plans next year

MedPAC recommends ‘measured approach’ to Medicare telehealth coverage


The Medicare Payment Advisory Commission shied away from recommending policymakers expand telehealth coverage for specific services and instead urged CMS to evaluate cost, access and quality by launching pilot projects through CMMI

A rapidly depleting Medicare fund could renew calls for major reform


It appears congressional Republicans have received new ammo in their long-term quest to reform the Medicare program following a recent trustees report which found the program has a shorter shelf-life than previously thought

Looking for lower Medicare drug costs? Ask your pharmacist for the cash price


Medicare officials recently told insurers to knock off costly "gag clauses" but stopped short of requiring them to lift such restrictions on pharmacists. So how can patients make sure they don't overpay? It's as simple as asking

CMS announces MyHealthEData Initiative and Medicare Blue Button 2.0

Medicine and Technology

Department of Health and Human Services (HHS) – including its Centers for Medicare & Medicaid Services (CMS), Office of the National Coordinator for Health Information Technology (ONC), and National Institutes of Health (NIH) – as well as the U.S. Medicare’s Blue Button 2.0 is a new and secure way for Medicare beneficiaries to access and share their personal health data in a universal digital format. Medicare’s Blue Button 2.0

To benefit of physicians, CMS to test Medicare Advantage as an advanced APM


Under a demonstration project, CMS will move ahead with plans to test whether certain Medicare Advantage plans should qualify as an advanced alternative payment model and exempt doctors from MIPS

JAMA piece urges release of Medicare Advantage encounter data


Despite concerns about the quality of Medicare Advantage encounter data, a new JAMA viewpoint piece argues that it's long past time to make that information available to researchers who want to study the ever-growing privatized Medicare program.

Medicare reimbursement caught in the crosshairs of congressional opioid talks


Lawmakers on an influential House committee appear to be looking at Medicare reimbursement as the main culprit of opioid overprescribing. Payment changes for alternative treatments may be in order, and providers say they are "inadequately compensated" for time spent screening patients for addiction or checking drug registries

CMS floats proposal tying medical records sharing to Medicare participation


Buried underneath changes to the Meaningful Use program, a newly proposed hospital payment rule includes the possibility of more stringent requirements that would require providers to share data to participate in the Medicare program. Experts said the agency could also leverage that approach to give TEFCA more teeth