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 296

Medicare Regulations 296

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 286

Medicare Regulations 286

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

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 261

Regulations Medicare 261

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 291

Medicare Regulations 291

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

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

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

Fierce Healthcare

APRIL 23, 2024

Interoperability mandates from the Centers for Medicare and Medicaid Services (CMS) have required major investments by health plans in recent years and will continue to be critical in informing ove | Facing new CMS mandates, MVP Health Care Chief Strategy Officer offers considerations to align your compliance strategy with innovation goals.

Regulations 130

Regulations Medicaid Medicare 130

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 320

Medicaid Home Care Regulations Medicare 320

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 296

Medicare Regulations 296

Home Health Care

FEBRUARY 13, 2024

However, there is a tension that exists between the demand for those alternative care models and the regulations from the federal government that could drastically affect them. Regulatory tension Medicare covers home health care, but not personal care, which generally helps seniors deal with activities of daily living.

Regulations 115

Regulations Home Care Law Firms Medicaid 115

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 310

Medicare Regulations 310

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 315

Regulations Medicare Hospitals 315

Health Populi

JUNE 17, 2024

You would assume that most people over 50 would be worried about the financial future of Medicare to cover health care as those middle-aged Americans age. The most cost-secure are people over 65 (read: Medicare-secure, among two-thirds) and younger people 18 to 29 (6 of whom lack confidence to pay for health care as they age).

Medicare 71

Medicare Medical Services Integration Regulations 71

HIT Consultant

NOVEMBER 24, 2022

The Food & Drug Administration’s new over-the-counter (OTC) hearing aid regulations are now in effect and health plans are starting to explore what it means for them. The regulations may provide an opportunity for health insurers to attract new members – and retain existing ones – with hearing loss. Expanding membership.

Regulations 98

Regulations Medicare Quality of Care Integration 98

Home Health Care

NOVEMBER 8, 2021

Since the Centers for Medicare & Medicaid Services (CMS) released its interim emergency regulation relating to the federal government’s vaccine mandate last Thursday, more clarity has come to the surface. The post ‘Layer Upon Layer of Regulation’: Breaking Down the CMS Vaccination Mandate appeared first on Home Health Care News.

Regulations 98

Regulations Medicaid Medicare 98

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 276

Medicare Regulations 276

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 296

Regulations Medicare 296

Home Health Care

OCTOBER 23, 2023

Insurance companies selling Medicare Advantage (MA) plans have been facing increased scrutiny from members of Congress and regulators, with critics of the private version of Medicare claiming carriers are profiting far too much. There was a 364% increase in plans offering the benefit since 2020. The agency is implementing a 3.3%

Medicare 109

Medicare Home Care Primary Care Regulations 109

Health Care Dive

OCTOBER 31, 2023

Regulators on Monday proposed a long-awaited rule tying payments for hospitals and doctor’s offices in three popular Medicare programs to compliance with data-sharing regulations.

Regulations 187

Regulations Doctors Medicare Hospitals 187

Readiness Rounds

OCTOBER 3, 2023

The Tightening Grip of CMS Regulations 2. The rules of unannounced visits from regulatory bodies have been significantly tightened by the Centers for Medicare & Medicaid Services (CMS) making it crucial for healthcare facilities to be constantly prepared. Headlines: 1. Key Takeaways 5.

Regulations 52

Regulations Performance improvement Patient Safety Hospitals 52

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

Home Health Care

NOVEMBER 7, 2023

Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030. million Medicare fee-for-service beneficiaries are assigned to an ACO. Currently, roughly 13.2 We’d like to try it that way.’

Medicare 104

Medicare Accountable Care Home Care Accountability 104

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

Advanced Data Systems

JULY 19, 2022

Whether your patient population currently consists mostly of Medicare patients or only a portion, it’s imperative to stay on top of regulations and updates that the government issues regarding healthcare coverage. With that in mind, here’s a look at proposed Medicare fee schedule changes that are anticipated for 2023.

Medicare 75

Medicare Regulations Healthcare 75

Home Health Care

JANUARY 19, 2023

Home health providers should keep a close eye on the rise and popularity of managed care plans under Medicare Advantage in 2023. There is a strong sentiment of privatizing the Medicare program and offering it through managed care plans,” Dombi said. That trend is due to, in part, the sudden growth of Medicare Advantage.

Home Care 91

Home Care Medicare Regulations 91

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 340

Hospitals Regulations Medicare 340

Home Health Care

MARCH 6, 2024

In 2023, Medicare Advantage (MA) plan members represented more than half of all Medicare beneficiaries for the first time. The post UnitedHealthcare, Humana, Aetna Continue To Outgain Peers In Medicare Advantage appeared first on Home Health Care News. Seniors have more options than ever when choosing MA plans.

Medicare 52

Medicare Home Care Regulations Medicaid 52

Triage Health Law

JANUARY 11, 2023

Pursuant to federal regulations that took effect on January 1, 2023, individuals who lose Medicaid coverage will be granted a special enrollment right to enroll in Medicare Part B coverage. [1] Medicare Part A covers hospital services. Medicare Part B covers doctors visits, outpatient services and certain other services. [2]

Medicaid 59

Medicaid Medicare Regulations Doctors 59

HIT Consultant

APRIL 17, 2024

What You Should Know: Wolters Kluwer Health , a leading provider of healthcare information and analytics, has introduced a new weapon in the fight against potential financial penalties for Medicare Advantage Organizations (MAOs) – the Regulatory Audit Module. The Centers for Medicare & Medicaid Services (CMS) estimates a staggering $4.7

Medicare 52

Medicare Regulations Medicaid Healthcare 52

p3care

MAY 31, 2024

Regulatory Compliance ACOS must adhere to rules set forth by government bodies such as CMS (Centers for Medicare and Medicaid Services). Complying with all these regulations helps in avoiding penalties. These initiatives enhance the quality of care for individuals with traditional Medicare.

Quality of Care 130

Quality of Care Doctors Medicare Patient Experience 130

Briggs Healthcare

JULY 12, 2023

Background: Medicare Regulation 42 CFR section 405.378 provides for the assessment of interest at the higher of the current value of funds rate (one percent for calendar year 2023) or the private consumer rate as fixed by the Department of the Treasury. Note the Effective/Implementation Date is July 17, 2023. GENERAL INFORMATION A.

Medicare 52

Medicare Regulations Healthcare 52

Briggs Healthcare

MAY 4, 2023

This final rule will also codify regulations implementing section 118 of Division CC of the Consolidated Appropriations Act, 2021, section 11404 of the Inflation Reduction Act, and includes provisions that will codify existing sub-regulatory guidance in the Part C, Part D, and PACE programs.

Medicare 40

Medicare Regulations Nursing Primary Care 40

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 312

Telemedicine Primary Care Regulations Doctors 312

Briggs Healthcare

JANUARY 31, 2023

Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), finalized the policies for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program, which is CMS’s primary audit and oversight tool of MA program payments.

Medicare 40

Medicare Accountability Regulations Medicaid 40

Briggs Healthcare

DECEMBER 2, 2021

While CMS remains confident in its authority to protect the health and safety of patients in facilities certified by the Medicare and Medicaid programs, it has suspended activities related to the implementation and enforcement of this rule pending future developments in the litigation.

Medicaid 97

Medicaid Medicare Regulations Healthcare 97