All Articles In 'Tag Archives: 'Medicare''
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 [...]
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 [...]
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 [...]
Physicians and Medicare: Report Cites Data Limitations When Reviewing Physicians Who Opt Out of Medicare
It is difficult to understand why physicians drop out from serving Medicare beneficiaries, says a new report from the HHS Office of the Inspector General (OIG). The OIG details data limitations encountered when reviewing physicians opting [...]
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 Advantage and Preventative Services: GAO Finds Preventative Care Services and Clinical Recommendations Could Be Better Aligned
Because preventative care can reduce expenditures and improve health outcomes, the GAO conducted a study examining actual preventative service use in relation to the U.S. Preventative Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) [...]
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