Medicare & CMS

CMS 340B drug discount program
New 340B Guidelines Target Program Abuses

The Centers for Medicare and Medicaid Services (CMS) announced changes to its 340B Drug Discount Program, effective January 1, 2018. The primary difference in the program is that drug payments to participating hospitals will be cut. Under the original plan, CMS reimbursed hospitals at the average drug cost plus 6…

List of ACOs
CMS to Divulge Patient ACO Status

In the wake of provider criticisms, CMS has updated how physicians will be made aware of which patients will be monitored for the Medicare ACO program. Medicare beneficiaries will now be allowed to list their primary care provider on the Medicare website. If the doctor is part of an ACO,…

top hospitals by payor mix
Top Hospitals by Medicaid and Medicare Payor Mix

According to a survey released by the Medical Group Management Association (MGMA), operating expenses for medical practices increased at nearly the same rate as revenue between 2015 and 2016. Practices with increased revenue primarily attribute this growth to a greater number of non-physician providers (NPP) and key support staff. The…

Knee replacement
CMS Proposes Joint Replacement Coverage at ASCs

CMS announced on August 5 that they are considering whether to provide coverage for hip and knee replacement surgeries at outpatient surgery centers. This kind of coverage could further incentivize patients to choose ambulatory surgery centers (ASCs) over traditional hospitals for outpatient procedures, which worries some hospital leaders. Not only…

Community Health Centers
Why Some States Declined to Expand Medicaid

The vast majority of healthcare organizations and professional groups support Medicaid expansion, the Obamacare initiative to widen eligibility for Medicaid to individuals earning up to 138% of the federal poverty level. To them, the benefits of expansion, such as less bad debt and uncollectible bills, better patient access to services,…

top hospitals by payor mix
GAO: CMS Bidding Program Cuts down on DME Fraud

A new report from the GAO found that CMS’ competitive bidding program for durable medical equipment (DME) may have unexpectedly cut down on device fraud and overutilization. The program was initially launched in 2007 to ensure that Medicare paid for medical supplies and devices at reasonable market rates, which was…

Mergers and Acquisitions
Bundled Payments: Tipping Point in Value-Based Care?

The Centers for Medicare and Medicaid Services’ (CMS) latest bundled payments proposal takes a bold step toward addressing Medicare payment reform for some of the most common, complicated, and costly care scenarios in U.S. healthcare. The Bundled Payments for Care Improvement (BPCI) program was launched in 2011 based on provisions…

1 2 4