Federal spending for major healthcare programs are estimated to increase by $55 billion, or 6%, in 2016 after a technical adjustment for payment timing shifts, according to a report from the Congressional Budget Office.
A year after settling billing disputes with 2,022 hospitals for 68 cents on the dollar to clear a huge backlog of audit appeals, the government has revealed who got paid and how much.
Not-for-profit co-ops and other small health plans have been the leading critics of risk adjustment. Now, Aetna is right behind them.
Several states may be pocketing federal dollars to run hospitals that have been taken over by private companies, HHS' inspector general's office warned on Friday.
The CMS is asking the public for information about providers and organizations that may be steering Medicare- or Medicaid-eligible patients toward the Affordable Care Act's insurance exchanges in order to receive higher reimbursement rates.
The drug with by far the highest cost, despite the lowest claim count of the 10 most expensive, was Gilead's hepatitis C treatment Sovaldi at more than $3.1 billion. Next were Nexium, which treats gastroesophageal reflux disease, and the cholesterol drug Crestor.
Most physicians are expected to opt for the Merit-based Incentive Payment System, known as MIPS, rather than assume the downside risk of alternative payment models.
Data Points for the week of Aug. 15, 2016, covered the following topics: The CMS' new star ratings for overall quality of hospitals
Hospitals with higher than average spending in cardiology services could face penalties as a result of the CMS' proposed bundled-payment program for bypass surgery and heart attacks, according to a new analysis.
The federal government will expand a new Medicare Advantage program to three states in 2018 and allow interested insurers to offer expanded benefits to two new types of chronically ill members.
The CMS is hoping to increase use of a decades-old program meant to care for people who are dually eligible for Medicare and Medicaid by making a few policy tweaks to the program.
A federal appeals court resurrected a whistle-blower case against UnitedHealthcare, Aetna and healthcare companies for allegedly submitting false data for Medicare Advantage payments.