Medicare
A new analysis of more than 3 million claims for Medicare patients found that patients enrolled in a managed Medicare Advantage plan had better health outcomes than those senior enrolled in the traditional fee-for-service Medicare model.
The American Orthotic and Prosthetic Association (AOPA) is suing the Department of Health and Human Services over 2011 rule changes for prosthetic reimbursements requiring physician documentation, which the association claims is wreaking financial havoc on O&P practitioners due to prepayment audits and retroactive application.
The federal government has uncovered a string of alleged Medicare fraud attempts totalling $223 million and involving 89 individuals in eight cities.
The Centers for Medicare & Medicaid Services (CMS) is looking to more than a dozen dual eligible demonstrations to fulfill the quality improvement and cost saving aims of the Affordable Care Act, although in the five demonstrations approved so far, the exact sources of projected savings remain largely unclear, according to the Kaiser Family Foundation.
Humana has named its first chief medical officer, Roy Beveridge, MD, an oncologist and internist currently working as CMO at McKesson Specialty Health.
On Wednesday, insurer and managed care company Humana Inc. reported a significant increase in earnings for the first quarter of 2013 based on lower utilization of medical services and outperformance by virtually all sectors of the company's business.
The Centers for Medicare & Medicaid Services proposed April 26 its fiscal 2014 Medicare payment schedule. Included in the proposal are payment cuts to hospitals that treat uninsured individuals and slightly higher rates for acute care and long-term care hospitals. The proposal also prepares the groundwork for a program that imposes a penalty on facilities that lag on reducing the frequency of hospital-acquired conditions.
Five members of the Senate Finance Committee, including outgoing Montana Senator and Affordable Care Act architect Max Baucus, say they plan to draft policy proposals for reducing Medicare and Medicaid fraud and abuse based on input from more than 100 healthcare organizations.
Consumer advocates and some lawmakers are promoting a new bill they say would save Medicare $141 billion over the next decade by requiring prescription drug rebates for Medicaid-Medicare eligible patients and low-income Medicare beneficiaries.
The Medicare Payment Advisory Commission (MedPAC) on Friday debated how to change the payment method for chronically critically ill patients in acute care and long-term care hospitals so they are more accurate and based on patient needs.
Under a withering barrage of pressure from the insurance industry, seniors groups and Congressional members from both sides of the aisle, CMS on Monday did an about face and significantly raised its 2014 growth percentage estimate for the Medicare Advantage program.
Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state's powerful hospital industry.
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