All Articles In 'Providers'
Medicare-Medicaid Dual Eligibles: Learn Basics of $350 Billion Market at Webinar on May 23, 2012
The nation’s 9 million Medicare-Medicaid dual eligibles - low-income frail seniors and persons of all ages with severe disabilities - now use about $350 billion in healthcare annually. States and CMS are rolling out models to integrate Medicare [...]
Medicaid Upper Payment Limits: Understanding Federal Limits on Medicaid Fee-For-Service Reimbursement of Hospitals and Nursing Homes
Medicaid financing is extremely complex. Federal upper payment limits on hospitals, nursing facilities, and other healthcare providers are a case in point. Here is a quick primer. Origins of Upper Payment Limit: The Upper Payment Limit [...]
Health IT and Care Coordination: Role of Health Information Technology in Care Coordination
Care coordination is a process that ensures a patient’s health services and information sharing preferences and needs are met. Care coordination, a critical component during the nation’s current shift from a fragmented system toward one that [...]
Medical Devices and the FDA: FDA Taking Longer to Approve New Medical Devices for U.S. Market
The Food and Drug Administration (FDA) reviews the safety and effectiveness of new medical devices sold in the United States, and The Medical Device User Fee and Modernization Act of 2002 (MDUFMA) authorizes FDA to collect [...]
Comparative Effectiveness Research: How Agency for Healthcare Research and Quality Spent $474 Million in ARRA Funds
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 [...]
Medicaid Program Integrity: Federal Investigations, Audits, and Evaluations to Combat Medicaid Waste, Fraud, and Abuse
In its latest Medicaid Integrity Program Report, the HHS Office of Inspector General (OIG) outlines Medicaid program integrity activities for FY 2011, including Medicaid-related audits and evaluations and Medicaid-related legal and investigative outcomes. Funding was employed [...]
Health Plans and Quality Improvement Reporting Under the Affordable Care Act: Recommendations for Implementing Reporting of Quality Improvement Strategies
The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) issue employer group health plan quality improvement reporting requirements. Reports shall cover specified quality improvement activities regarding plan or coverage benefit and [...]
Essential Health Benefits: Preliminary Analysis of Essential Health Benefits and Potential Benchmark Health Benefit Plans for Virginia
The Patient Protection and Affordable Care Act (ACA) requires benefit plans offer a minimum set of essential health benefits. Those include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use [...]
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 [...]
Nursing Home Quality: Improving Efforts to Monitor Implementation of the Quality Indicator Survey
Nursing homes that receive federal Medicaid or Medicare funding must meet federal quality standards. The Centers for Medicare and Medicaid Services (CMS) and states, accountable for ensuring compliance, inspect nursing facilities periodically using a CMS-developed and state-administered survey or [...]
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