Medicare Advantage star ratings to be released

By Bob Herman  |  October 03, 2015

The CMS will release 2016 star ratings for each Medicare Advantage plan on Thursday, and experts predict more insurers will receive higher quality scores as they adapt to the government's more rigorous standards.

Critical-access hospitals see little growth

By Michael Sandler  |  October 03, 2015

Despite the outcry on Capitol Hill over rural hospital closings, the number of critical-access hospitals in the U.S. grew slightly in the past year, according to Modern Healthcare magazine's annual review of CMS data.

Rehab care reimbursement under renewed fire from OIG

Rehab care reimbursement under renewed fire from OIG

By Melanie Evans  |  October 03, 2015

A majority of frail Medicare patients who enter nursing homes in need of rehabilitation therapy now receive higher-paying intensive therapy before they leave, a major shift from just years ago, despite no evidence that such therapy is needed. The shift makes the rehab arena an attractive target for...

Medicare, Medicaid are leaders in improper payments

By Shannon Muchmore  |  October 01, 2015

Medicare and Medicaid are two of the top three government programs making improper payments, and several steps should be taken to reduce those amounts, the U.S. comptroller general said during a Senate hearing Thursday.

OIG report suggests nursing homes game Medicare

By Melanie Evans  |  September 30, 2015

Nursing homes that have seen little change in the age or ailments of their patients have increasingly billed Medicare for highly intensive and profitable services at significant cost to the program, according to a new report that may spur the government to change how the facilities are paid.

Is New York's duals demonstration on verge of collapse?

By Virgil Dickson  |  September 30, 2015

New York state's experiment to better coordinate care for low-income and disabled residents who are dually eligible for Medicaid and Medicare is losing hundreds of enrolled beneficiaries.

Medicare's $30M ambulance-ride mystery

By Associated Press  |  September 29, 2015

Medicare paid $30 million for ambulance rides for which no record exists that patients got medical care at their destination, the place where they were picked up or other critical information.

CMS tests model to increase drug adherence on Part D plans

By Virgil Dickson  |  September 28, 2015

The CMS is launching an experiment to increase medication adherence for Medicare beneficiaries on Part D plans. The goal is to improve patient care, avoid hospitalizations and emergency room visits, and save money for Medicare.

CMS proposes $5 billion cut in lab test fees

By Virgil Dickson  |  September 25, 2015

The CMS has proposed paying private insurance rates for clinical diagnostic laboratory tests beginning on January 1, 2017, which would lead to sharply lower prices for Medicare.

Blog: Is 'value-based care' more than a marketing slogan?

By Bob Herman  |  September 24, 2015

The U.S. healthcare system is investing a lot of time, energy and money into the concept of value-based care, and a fascinating commentary in the New England Journal of Medicine hits that idea squarely in the gut.

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