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Dialysis pay-for-performance looms

By Sabriya Rice  |  July 04, 2015

In an effort to improve outcomes at the nation's 6,000 dialysis facilities, Medicare plans to cut reimbursement rates up to 2% if the facilities perform poorly on an expanded set of quality metrics.

Dialysis providers to get modest Medicare rate bump

By Virgil Dickson  |  June 26, 2015

The CMS proposed a 0.3% rate increase for end-stage renal disease services for 2016. The proposal also modifies Medicare's quality incentive program for dialysis providers.

Feds expand probe into DaVita's Medicare Advantage practices

Feds expand probe into DaVita's Medicare Advantage practices

By Lisa Schencker  |  June 24, 2015

The federal government has expanded its investigation into DaVita HealthCare Partners' Medicare Advantage risk-adjustment practices, DaVita revealed in a Securities and Exchange Commission filing Wednesday.

CMS rattles Medicaid directors with guidelines for managed-care rates

By Virgil Dickson  |  June 22, 2015

New CMS guidelines intended to ensure Medicaid managed care plans are adequately reimbursed will frustrate state agencies and create paperwork the CMS might not have the staff to handle, according to the National Association of Medicaid Directors.

Feds signal sharper scrutiny of doc pay deals

By Lisa Schencker  |  June 13, 2015

HHS has signaled its intent to more rigorously enforce the anti-kickback statute against individual physicians who enter into improper payment deals, following a dozen recent civil settlements involving doctors.

Out-of-network charges under fire

Out-of-network charges under fire

By Bob Herman  |  June 06, 2015

Hospitals contend that their high and extremely variable chargemaster prices shown in new CMS data are misleading because very few patients are asked to pay them. But the rates are a growing concern as more patients face unexpected out-of-network bills.

Latest physician data spotlight how Medicare pays for drugs

Latest physician data spotlight how Medicare pays for drugs

By Bob Herman  |  June 06, 2015

Medicare paid out hundreds of millions of dollars to a small subset of physicians in 2013, but most of those payments to top Medicare billers covered the costs of drugs administered to patients in clinicians' offices.

Medicare should end penalty for high-performing systems under ACO model

Medicare should end penalty for high-performing systems under ACO model

By Dr. James Weinstein and Dr. William Weeks  |  June 03, 2015

Imagine a company that produces a high-quality product, operates efficiently and generates $16 million in year-over-year savings. Then imagine that the company isn't allowed to retain those savings, but is assessed a penalty. Hard to imagine? Well, it's a reality in the U.S. healthcare system today.

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