All Articles In 'Medicare Payment'
Medicare Advantage Risk Adjustment: GAO Recommends CMS Risk Score Adjustments for Diagnostic Coding
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent [...]
Medicare Fee-for-Service Benefits: Impact of Medicare Cost Sharing Changes on Beneficiaries and Budget
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service [...]
HHS Reports That Only 14 Percent of Patient Harm Events Experienced by Medicare Beneficiaries Are Captured
A study conducted by the HHS Office of Inspector General, Hospital Incident Reporting Systems Do Not Capture Most Patient Harm, analyzed the ways in which hospitals use incident reporting systems and incident reports to determine how [...]
Medicare Secondary Payer: Options for Improving Medicare Payment Recoveries from Individual, Non-Group Health Plans
The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware [...]
Lack of Price Transparency Could Limit Hospitals’ Ability to Secure Favorable Pricing for Implantable Medical Devices
Policymakers expressed concern about the lack in price transparency for implantable medical devices (IMD), with confidentiality clauses in purchasing agreements frequently restricting the release of third-party prices. Because this lack of transparency could drive up hospital [...]
Medicare: American Enterprise Institute for Public Policy Research Finds Competitive Bidding Could Solve Fiscal Crisis
As a natural outcome of program incentives, physicians and other health care providers are motivated to deliver more services as a means to increase Medicare fee-for-service (FFS) payments. Chronic overtreatment, and the resulting overpayment, has led [...]
Medicare Advantage and Risk Adjustment: GAO Advises CMS to Improve Risk Score Adjustments for Diagnostic Coding
Over time, the Centers for Medicare and Medicaid Services (CMS) has revised the risk adjustment methodology for Medicare Advantage plan payments. The risk adjustment process calculates a risk score for each Medicare Advantage (MA) plan enrollee, [...]
Medicare Payment Reform and Quality Improvement: MedPAC Recommendations to Congress on Medical Imaging and Poor Quality Providers
The Medicare Payment Advisory Commission (MedPAC) has made 10 new recommendations to Congress regarding Medicare payment accuracy and financial incentives for medical imaging and other diagnostic testing, and quality improvement, targeting the worse performing Medicare providers [...]
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