The CMS has finalized a controversial rule that will require providers to return Medicare overpayments. The rule, first proposed in 2012, alarmed many healthcare organizations when it floated the idea that providers would be liable for returning Medicare overpayments going back as far as 10 years.
As the CMS seeks to simplify the application process for exchange plans and Medicaid, payers want to make it harder for individuals to sign up after open enrollment ends. Meanwhile, advocates and providers want to reduce barriers and have the CMS learn more about who is signing up, including their...
HHS says that 12.7 million people signed up for 2016 coverage through the insurance exchanges, well within previously stated expectations. Now the Obama administration must ensure that the risk pool evens out so that premiums will stabilize and insurers will remain interested in selling the plans.
The CMS' Hospital Readmissions Reduction Program is the policy vanguard of the transition from process to outcome measures for hospital reporting and payment.
Virginia has submitted a waiver to the CMS to transform its Medicaid program and move the state's most vulnerable populations into managed care.
The Obama administration is working to balance patient privacy with the promise of tapping into market forces to boost its 4-year-old initiative to allow outside organizations to mine federal claims data for healthcare quality improvement and cost containment.
Most insurers have embraced the ACA, and it has helped many of them financially through the tacit encouragement of products such as high-deductible plans. But many still puzzle over how to pivot beyond what was long the core of their business: employer-based plans and holding down medical claims.
Mary Brainerd, CEO of HealthPartners, discusses her system's foray into insurance, the challenges faced by providers that want to make similar moves and her own experience in the healthcare system as a patient with breast cancer. She spoke with Modern Healthcare reporter Bob Herman.
A growing number of medical schools in the U.S. are immersing students in the nitty-gritty of direct patient contact and care from the start of their training. The schools' aim is to produce physicians who are more in tune with team-based and patient-centered care.
Some medical data miners may soon be allowed to share and sell Medicare and private-sector medical-claims data, as well as analyses of that data, under proposed CMS regulations.
The CMS wants to change how it evaluates whether the Medicare Shared Savings Program's accountable care organizations save money. The agency proposes moving away from assessing ACO benchmarks based on historical spending. It instead would analyze trends in regional fee-for-service costs.
In 2009, Dr. Edward Callahan was overseeing a task force at the University of California at Davis that was tackling the issue of integrating sexual orientation and gender identity information into electronic health records.