Health Care Dive

NOVEMBER 3, 2023

Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.

Doctors 305

Doctors Medicare Hospitals Regulations 305

Health Care Dive

SEPTEMBER 9, 2022

A small proportion of providers that billed for telehealth — 1,714 out of 742,000 — posed a high risk of fraud or abuse to Medicare in COVID-19’s first year, regulators found.

Medicare 274

Medicare Regulations 274

Home Health Care

OCTOBER 30, 2024

Medicare Advantage (MA) star ratings have become a hot topic for Humana Inc. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) over its drop in star ratings. NYSE: HUM). 18, the company filed a lawsuit against the U.S. Rechtin said this in relation to Humana’s 3% margin target.

Medicare 105

Medicare Primary Care Regulations Medicaid 105

Health Care Dive

AUGUST 24, 2022

The Better Medicare Alliance is arguing that marketing materials for MA plans are already subject to “careful regulation” and adhere to a 53-page set of federal guidelines.

Medicare 246

Medicare Regulations 246

HIT Consultant

DECEMBER 23, 2024

Brian Norris, Managing Director of Strategic Consulting at MedeAnalytics There are almost 33 million people enrolled in eligible Medicare programs. Nearly half are enrolled in Medicare Advantage (MA) plans, and that number is expected to continue its climb.

Medicare 97

Medicare Population Health Integration Regulations 97

Health Care Dive

JUNE 22, 2022

The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments.

Medicare 307

Medicare Regulations 307

Health Care Dive

JANUARY 8, 2024

The payer is taking issue with how regulators calculated quality scores for 2024, after seeing a stars decline that could cause its bonus revenue to fall by $500 million.

Medicare 293

Medicare Regulations 293

Health Care Dive

OCTOBER 23, 2024

Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.

Medicare 274

Medicare Regulations 274

HIT Consultant

OCTOBER 22, 2024

This provided agencies with broad discretion to create and enforce regulations that often filled gaps left by legislators. Implications for Cybersecurity in Healthcare Vulnerability of Existing Regulations The immediate impact of this ruling is the increased vulnerability of existing cybersecurity regulations to legal challenges.

Healthcare 139

Healthcare Regulations Medicaid Medicare 139

Health Care Dive

JUNE 14, 2024

The redo comes after regulators lost two court cases over the methodology used to determine 2024’s quality ratings, and should result in hundreds of millions of dollars in additional bonuses to plans that see their ratings improve.

Medicare 274

Medicare Regulations 274

Health Care Dive

NOVEMBER 4, 2024

The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.

Medicare 259

Medicare Regulations 259

Health Care Dive

FEBRUARY 14, 2024

High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project.

Medicare 283

Medicare Regulations 283

Health Care Dive

FEBRUARY 1, 2024

However, analysts said regulators will likely improve the payment rate in the final notice. The CMS proposed a 0.2% dip in MA rates.

Medicare 288

Medicare Regulations 288

Health Care Dive

FEBRUARY 27, 2024

Medicare Advantage payment per month, per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.

Medicare 210

Medicare Regulations 210

Health Care Dive

NOVEMBER 25, 2024

A Texas federal judge has sided with UnitedHealthcare in determining regulators messed up calculating its Medicare Advantage quality scores for next year. The decision could have big implications for similar pending cases.

Regulations 313

Regulations Medicare 313

Health Care Dive

JULY 11, 2024

Regulators said Medicare’s budget neutrality requirement is to blame for the reduction, which was quickly decried by provider groups. However, it’s likely Congress will step in to mitigate the drop.

Regulations 312

Regulations Medicare 312

Fierce Healthcare

APRIL 22, 2024

The Centers for Medicare & Medicaid Services is hoping to improve Medicaid enrollees’ access to care through a final rule that better compensates caregiving roles. | CMS released a series of final rules Monday, including Medicaid access regulations that some groups worry will cause providers to close.

Medicaid 318

Medicaid Home Care Regulations Medicare 318

Fierce Healthcare

FEBRUARY 13, 2024

Private equity firms have seen plenty of potential in the rapidly growing Medicare Advantage space, but deal volumes are slowing, according to a new report. Private equity firms have seen plenty of potential in the rapidly growing Medicare Advantage space, but deal volumes are slowing, according to a new report.

Regulations 258

Regulations Medicare 258

Health Care Dive

AUGUST 17, 2021

An HHS watchdog says Medicare could see significant cost savings if regulators did away with the carveout. Currently, new facilities help pay for their capital costs through a special exemption.

Hospitals 339

Hospitals Regulations Medicare 339

Health Care Dive

SEPTEMBER 12, 2023

The survey from the Commonwealth Fund comes after regulators finalizing a rule this spring that aims to cut back on deceptive or misleading advertising for MA plans after beneficiary complaints more than doubled between 2020 and 2021.

Medicare 293

Medicare Regulations 293

Fierce Healthcare

AUGUST 20, 2024

Amid significant scrutiny from lawmakers and regulators on Medicare Advantage, a new report suggests that consumer satisfaction with these plans is notably higher than with commercial insurance.

Regulations 284

Regulations Medicare 284

Health Care Dive

JANUARY 30, 2023

Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments.

Medicare 274

Medicare Regulations 274

Fierce Healthcare

MARCH 4, 2024

A bipartisan spending bill unveiled Sunday narrows some of this year’s cuts to physician Medicare pay, pushes back scheduled disproportionate share hospital (DSH) payment cuts and increases annual | A 1,050-page bill unveiled Sunday included several key lobbying focuses for providers but excludes other hot-button topics like potential pharmacy benefit (..)

Regulations 312

Regulations Medicare Hospitals 312

Health Care Dive

JUNE 9, 2023

Regulators said they're trying to work around restrictions regarding what groups Medicare is allowed to pay as they look to address social determinants of health.

Regulations 293

Regulations Medicare 293

Healthcare It News

OCTOBER 4, 2022

The Electronic Healthcare Network Accreditation Commission and The CARIN Alliance have partnered to bring both the CARIN Code of Conduct and EHNAC’s criteria review process to health plans, health systems, EHR vendors and others for reporting to the Centers for Medicare & Medicaid Services on their data practices and privacy protections.

Regulations 347

Regulations Medicaid Medicare Healthcare 347

Healthcare It News

MAY 31, 2023

They also said clinicians reported needing more formal training on how to communicate more effectively over a virtual platform and about state regulation. Regulations that varied widely also affected their use of telehealth platforms. But the telehealth boom during the pandemic proved virtual primary care inspires several value-ads.

Telemedicine 360

Telemedicine Primary Care Regulations Doctors 360

Health Care Dive

AUGUST 15, 2023

Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to form groups to manage care and costs for fee-for-service Medicare enrollees.

Accountable Care 245

Accountable Care Regulations Accountability Medicare 245

Health Care Dive

JULY 14, 2023

Regulators also proposed stricter price transparency requirements on hospitals and expanded behavioral health payments in Medicare.

Regulations 235

Regulations Medicare Hospitals 235

HIT Consultant

DECEMBER 3, 2024

The Centers for Medicare & Medicaid Services (CMS) added codes for Digital Mental Health Treatment in its 2025 Medicare Physician Fee Schedules. This means the prescription of digital mental health therapeutics can now be billed thru Medicare and Medicaid, paving the way for private insurance to do the same.

Health Technology 111

Health Technology Physical Therapy Regulations Medicare 111

Home Health Care

MARCH 11, 2025

Our Medicare program has evolved over the past decade, and we are here to ensure that patients have sufficient access to care. Madison spoke about her 31 years of experience running a home health agency, where traditional Medicare covered most patients. These are not just policy decisions, Fleece stated.

Home Care 100

Home Care Medicaid Rehabilitation Medicare 100

Home Health Care

JANUARY 31, 2024

The Medicare enrollment process undergoes annual changes at the Centers for Medicare & Medicaid Services (CMS) to ensure it remains up to date with evolving regulations, policies and health care practices. CMS recognizes that there are legitimate providers that do not bill Medicare even though they are enrolled,” Carr said.

Medicare 126

Medicare Regulations Medicaid Home Care 126

Home Health Care

NOVEMBER 8, 2024

Under fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous admission of drugs or biologicals to an individual at home. The quarterly average of HIT service visits was about 7,500 from 2021 to 2023, according to the Centers for Medicare & Medicaid Services (CMS).

Tricare 111

Tricare Medicare Nursing Medicaid 111

p3care

SEPTEMBER 26, 2023

Medicare and Medicaid are the two biggest healthcare insurance programs in the United States. The federal government has made different rules and regulations applicable to eligible populations. Therefore, receiving reimbursement for Medicare and Medicare cardiology billing seems difficult.

Medicaid 130

Medicaid Medicare Regulations Prevention 130

HIT Consultant

APRIL 19, 2024

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule.

Regulations 102

Regulations Nursing Medicare Medicaid 102

Triage Health Law

JULY 27, 2023

On May 10, 2023, the Center for Medicare & Medicare Services (“CMS”) issued guidance to clarify the definition of “marketing” for Medicare Advantage Plans (“MA Plans”) and Prescription Drug Plans (“PDPs”). [1] What led to the Change in Definition?

Medicare 98

Medicare Regulations Medicaid Prevention 98

p3care

MARCH 18, 2025

Value-based payment models are rising, and CMS (Centers for Medicaid and Medicare Services) incentivizes such models. Healthcare providers now need to understand and navigate new reimbursement models. It is now a battle between quality and quantity. This update refers to the more transparent medical billing services system.

Patient Safety 130

Patient Safety Healthcare Providers Regulations Healthcare Quality 130

Home Health Care

APRIL 3, 2025

Centers for Medicare & Medicaid Services (CMS), following his confirmation by the U.S. At CMS, Oz will oversee Medicare and Medicaid, the home health industrys biggest payers. The Medicare trust fund will be insolvent within a decade. Mehmet Oz will lead the U.S. Senate on Thursday. taken out of your paycheck.

Medicaid 101

Medicaid Medicare Hospitals Healthcare 101