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 232

Medicare Regulations 232

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 274

Medicare Regulations 274

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 233

Medicare Regulations 233

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 221

Medicare Regulations 221

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 210

Regulations Medicare 210

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

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 121

Medicare Regulations Medicaid Home Care 121

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 257

Regulations Medicare 257

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 206

Medicare Regulations 206

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 217

Medicare Regulations 217

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 318

Medicaid Home Care Regulations Medicare 318

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 283

Medicare Regulations 283

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 294

Medicare Regulations 294

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 109

Regulations Home Care Law Firms Medicaid 109

Home Health Care

JULY 18, 2024

This article is a part of your HHCN+ Membership The Centers for Medicare & Medicaid Services (CMS) isn’t letting up on cuts to home health payments, but its recent rulemaking in Medicare Advantage (MA) may end up benefiting home health providers indirectly. MA plans pay less than traditional Medicare does for home health services.

Medicare 95

Medicare Home Care Regulations Medicaid 95

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 308

Regulations Medicare Hospitals 308

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 97

Regulations Medicaid Medicare 97

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 269

Medicare Regulations 269

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 103

Medicare Home Care Primary Care Regulations 103

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

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

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 180

Regulations Doctors Medicare Hospitals 180

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 259

Regulations Medicare 259

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 76

Medicare Regulations Healthcare 76

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 93

Medicare Accountable Care Home Care Accountability 93

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 338

Hospitals Regulations Medicare 338

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 187

Accountable Care Regulations Accountability Medicare 187

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 82

Home Care Medicare Regulations 82

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

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

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

Health Care Dive

JULY 14, 2023

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

Regulations 160

Regulations Medicare Hospitals 160

Home Health Care

JULY 22, 2024

Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies. They were telling us that because they believed [providers] were making too much profit in the Medicare program.

Regulations 112

Regulations Home Care Medicaid Medicare 112

p3care

AUGUST 19, 2024

Frequent Changes in Billing Rules Healthcare regulations are constantly evolving, and OB/GYN billing is no exception. The Centers for Medicare & Medicaid Services (CMS) and private insurers frequently update billing guidelines, making it difficult to stay up-to-date for practitioners.

Regulations 130

Regulations Medicaid Medicare Healthcare Providers 130