Medicare & Medicaid

Jun 12 | Susan Morse

American Medical Association urges creation of APMs focused on at-risk populations

The AMA is advocating for appropriate risk adjustment of performance results based on clinical and social…

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Jun 07 | Susan Morse

CMS seeks input on Patients over Paperwork initiative to reduce red tape and to lower costs

Regulatory reform is estimated to save the healthcare system an estimated 40 million hours and…

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May 29 | Susan Morse

PACE final rule enforces patient protections through sanctions, monetary penalties

Programs of All-Inclusive Care for the Elderly organizations are also being allowed new flexibilities for…

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May 24 | Jeff Lagasse

First states to expand Medicaid saw larger screening rate increases

An additional 355,184 people would have been screened for colorectal cancer if non-expansion states had seen the same…

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May 20 | Jeff Lagasse

Private insurers in California pay more than double what Medicare does for similar services

The ratio of private insurance to Medicare payments is even higher than the 209 percent average at…

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May 15 | Susan Morse

CMS cracks down on spread pricing by pharmacy benefit managers

The spread amount must be included in the calculation of medical loss ratios that managed Medicaid and CHIP plans use to set…

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May 10 | Susan Morse

Private health plans pay providers at 241 percent of what Medicare would pay

Study recommends employers pressure health plans and hospitals to shift to contracts based on a multiple of…

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May 09 | Jeff Lagasse

Patients of Medicare providers committing fraud or abuse more likely to be poor, disabled

Fraudulent medical practice is estimated to cost the federal government between $90 to $300 billion…

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May 08 | Jeff Lagasse

Acadia Healthcare to pay $17 million in settlement of Medicare fraud case

Medicaid paid Acadia's facilities a much higher amount for blood and urine tests than its lab had charged for…

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May 08 | Susan Morse

Drug companies are being required to post list prices in TV ads

If pharmaceutical manufacturers are ashamed of their drug prices, then change the price, HHS Secretary Alex Azar says.

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Featured Resources

Care Collaboration Success for Improved Outcomes The nature of our healthcare ecosystem has been one of siloed care. Rarely do payers, providers and local resources come together with the patient's well-being prioritized as a unifying mission. Read how these organizations are getting it right.

Debunk the Myth: Outsourcing Doesn't Mean Losing Control With shifts in payer mixes and reimbursement structure, the margin of reimbursement has been shrinking steadily over the last five years. How do revenue cycle leaders navigate payment reform while maintaining stable business office operations?

Beyond Dollars and Cents: A Closer Look At Value Beyond the expected improvement in specific metrics, many organizations that outsource RCM with a trusted and certified partner are seeing several ancillary benefits of such agreements.

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Healthcare mergers and acquisitions in 2016: Running list While 2015 was a record-breaking year in healthcare mergers and acquisitions, 2016 saw more change as organizations across the industry adjust and adapt to the evolving financial landscape.

Analyze this: Health systems, health plans get to the core of big data Pamela Peele knows that people who subscribe to cooking magazines have a much higher risk of going to the emergency room. But how she knows that is a whole other story.

Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades When Leapfrog released their Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. ...

Whitepapers

Clinical Quality Measures 101 Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report ...

Credible, Defensible Estimates In healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data ...

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