All Articles In 'Tag Archives: 'CMS''
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 [...]
Medicare and Medicaid Spending: Enrollment Growth a Driver for Spending Increases
Much attention has been paid to the federal deficit, and a great deal of this discussion has centered on Medicare and Medicaid spending. As a means for controlling what has been considered “out of control” health [...]
Health Reform Implementation: Milestones for State Implementation of Health Insurance Exchanges, Medicaid Expansion, and Health Insurance Market Reforms
Under the Affordable Care Act (ACA), states are responsible for implementing a complex array of health reforms, most notably Health Insurance Exchanges, Medicaid expansion, and health insurance market regulations. ACA presents states, particularly state Medicaid agencies [...]
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 [...]
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 [...]
CBO Reports Medicare’s Demonstration Project Results
The Congressional Budget Office’s issue brief, Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment, provides details on the outcome of 10 major Medicare demonstrations following independent researcher evaluation. Demonstrations were conducted [...]
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 [...]
Medicare-Medicaid Dual Eligibles Market for Health Plans: Briefing by Kip Piper for Wall Street Analysts at Citi Global Healthcare Conference
The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care [...]
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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