The Political Plausibility of Medicare for All

Electronic Health Reporter

The article The Political Plausibility of Medicare for All appeared first on electronichealthreporter.com. Editorial Ken Perez Medicare for All OmnicellThis content is copyrighted strictly for Electronic Health Reporter. By Ken Perez, vice president of healthcare policy, Omnicell, Inc.

ACOs saved Medicare $2.7B to date, outpacing CMS estimates

FierceHealthIT

Accountable care organizations in the Medicare Shared Savings Programs have saved Medicare $2.7 billion to date, including $859 million in 2016, according to a new analysis commissioned by NAACOS. That's $1.1 billion more than CMS estimates

Big changes are coming to Medicare reimbursement for connected health

Mobi Health News

At HIMSS19, ACT | The App Association's Brian Scarpelli will lay out the details of what he calls a "sea change" in CMS' policy toward remote patient monitoring

CMS finalizes rule for remote patient monitoring reimbursement under Medicare

Mobi Health News

CMS Administrator Seema Verma said that the remote monitoring change and others would promote care innovation and reduce provider burden

Medicare Advantage Organizations Overturned 75% of Their Denials

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

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.

4 in 10 Medicare beneficiaries expected to be on Medicare Advantage plans by 2028

FierceHealthIT

Medicare Advantage enrollment is expected to increase from 34% of the Medicare population in 2018 to 42% in 2028. Yet CBO forecasts that spending on those enrollees will grow from $200 billion to $580 billion over the same time period

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: Cover CGMs Now!

Insulin Nation

Unfortunately, Medicare policy hasn’t kept up with evolving diabetes technology, and policymakers have left out CGMs from the list of reimbursable diabetes devices. There have been several petitions circulating to pressure lawmakers to make Medicare cover CGMs.

CMS Proposes to Expand Telehealth Benefits Under Medicare Advantage Plans

Healthcare Informatics

CMS is proposing to implement several sections of the Bipartisan Budget Act of 2018, including expanding telehealth benefits under Medicare Advantage plans

DOJ joins lawsuit accusing Sutter Health of Medicare Advantage fraud

FierceHealthIT

Federal prosecutors have intervened in a newly unsealed whistleblower lawsuit accusing Sutter Health of submitting unsupported diagnosis codes to Medicare Advantage plans, which inflated payments. The lawsuit comes weeks after DaVita's medical group paid $270 million to resolve similar allegations

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

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.

Medicare Payment Suspension & Termination

Healthcare Guys

Specifically, special attention should be paid to the business’s billing practices, and current Medicare policies and procedures concerning coverage and claims determinations To safeguard your business from payment interruption, providers and suppliers should ensure they have effective compliance measures in place.

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. Total Medicare reimbursement for all brand-name drugs ballooned 77 percent from 2011 to 2015.

The Centers for Medicare and Medicaid Approved Separate Reimbursements for Non-Traditional Patient Visits

eVisit

November 1, 2018 the Centers for Medicare and Medicaid (CMS) made a significant step in overcoming this obstacle. It announced its finalization of “ Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019 ”.

Federal watchdog: Nearly half of Medicare patients in long-term-care hospitals experienced harm

FierceHealthIT

Nearly half of Medicare patients in long-term-care facilities have experienced some type of harm as the result of their care, endangering their health and increasing Medicare costs, according to a report from a government watchdog

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 improperly paid $34M to medical equipment suppliers: OIG

FierceHealthIT

Medicare is only supposed to pay inpatient facilities for durable medical equipment used during patient stays. Yet OIG found $34 million that Medicare channeled directly to suppliers of such equipment between 2015 and 2017

Unbundled lab payments could add $10B to Medicare, GAO finds

FierceHealthIT

Although CMS' new lab fee schedule was designed to cut Medicare payments to labs, GAO says its implementation could authorize expensive unbundled lab payments

CMS appeals Medicare Advantage overpayment ruling

FierceHealthIT

A nuanced legal battle over Medicare Advantage overpayments rages on. CMS will appeal a September ruling invalidating a 2014 rule with huge implications for insurers, including UnitedHealth

Do Medicare providers located at a Distant Site have to be hospital-based to provide services?

Telehealth Blog

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

Medicare Told to Cover CGMs in Ruling

Insulin Nation

Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. The Medicare-insuring contractor denied the claim.

Healthcare and the F-Word: Health Politics Rank High on November 6, 2018

Health Populi

ACA Affordable Care Act Health Consumers Health costs Health insurance Health politics Health reform Healthcare access Medicaid Medicare“Let’s get this thing f-ing done,” Martha McSally passionately asserted on May 4, 2017. Paul Ryan said, on the floor of the U.S.

Zoeticx software allows improved care for RMCH Medicare patients

Healthcare Guys

Medicare patients going for their annual wellness checkups at the Rehoboth McKinley Christian Hospital are now seeing doctors take a whole new approach to their treatment, thanks to a partnership the hospital has made with a Silicon Valley software firm. Gallup Independent. August 27, 2018.

RACs returned $214M to Medicare in 2016

FierceHealthIT

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%

Medicare Advantage provider directories are riddled with errors. They're not the only ones

FierceHealthIT

Almost half of online Medicare Advantage directories contained incorrect or out-of-date information, CMS found in a recent investigation

Telehealth Place of Service Code

TeleMental Health blog

The Centers for Medicare and Medicaid Services (CMS) is a government agency within the US Department of Health and Human Services (HHS). CMS oversees insurance billing code sets in the United States.1 HCFA 1500 Form More precisely, as part of … Read more.

CMS to make Medicare Advantage data available to researchers

Morning eHealth

FDA draws strong, mixed reaction — U.S. Digital Service hands QPP back to CMS

Senate Hears Testimony for Medicare CGM Coverage

Insulin Nation

Despite the committee’s title, much of the testimony came from young people affected by Type 1 diabetes as part of a lobbying effort to get Medicare to cover continuous glucose monitors (CGMs). Two months later, a Medicare appeals council reversed the judge. The U.S.

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.

Consumer-facing Medicare plan tools are inaccessible and inaccurate, experts say

FierceHealthIT

Medicare Plan Finder frustrates many seniors, and there's a lot of confusion over what star ratings mean, said multiple speakers at AHIP's National Conference on Medicare

Medicare Holds Out Promise of Health Record Access Revolution

Society for Participatory Medicine

The possible new mandates, buried in a 479-page Federal Register “Notice of Proposed Rule Making” from the Centers for Medicare & Medicaid Services (CMS), could become part of hospital “conditions of participation” in Medicare.

DaVita group to pay $270M to settle Medicare Advantage false claims probe with DOJ

FierceHealthIT

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.

New Medicare marketing guidelines raise the specter of past predatory sales tactics

FierceHealthIT

The need for Medicare marketing regulations was crystal-clear 10 years ago. But a slew of changes to CMS' Medicare marketing guidelines this year expanded what plans can do at educational events, in providers' offices and more. Do these revisions create room for growth or opportunities for manipulation

DOJ cleared to force testimony from Anthem in Medicare Advantage fraud investigation

FierceHealthIT

A New York judge says Anthem must release testimony to federal prosecutors as part of a fraud investigation into the insurer’s Medicare Advantage plans.

Zoeticx software allows improved care for RMCH Medicare patients

Healthcare Guys

GALLUP — Medicare patients going for their annual wellness checkups at the Rehoboth McKinley Christian Hospital are now seeing doctors take a whole new approach to their treatment, thanks to a partnership the hospital has made with Zoeticx, a Silicon Valley software firm.

OIG: Medicare spent $5.7B on improper payments to inpatient rehab facilities

FierceHealthIT

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

CMS achieves lowest Medicare improper payment rate since 2010

FierceHealthIT

Improper payments in Medicare have been on the decline since Congress passed the Improper Payments Elimination and Recovery Act of 2010. They reached an eight-year low of 8.12% in the Medicare fee-for-service program this year, according to CMS

Humana expands Medicare Advantage network through new partnership with Heritage

FierceHealthIT

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

MACRA: New Reimbursement Legislation in the US

TeleMental Health blog

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is new legislation in the United States. In May 2018, the Center for Medicare and Medicaid Services Administration (CMS) released a brief but noteworthy document entitled, Summary of Policies in the … Read more. The post MACRA: New Reimbursement Legislation in the US appeared first on TBH Institute Blog.

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

Verma, Azar take aim at ‘Medicare for All' proposals

FierceHealthIT

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