CMS Final Rule Extends Federal Diabetes Prevention Program To Medicare Beneficiaries

The federal government is hoping to build upon the successes of their pilot diabetes prevention program, as they are moving forward with their plan to expand the prevention program model to all Medicare beneficiaries. The Department of Health and Human Services recently revealed that they are planning to expand the program, as it made impressive…

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HHS Will Provide Federal Financial Assistance To Eligible Marketplace Customers

The latest data released by the Department of Health and Human Services indicates that the median monthly premium for the second-lowest silver plan in the federal marketplace will significantly increase by 16 percent next year. However, HHS has stated that approximately three-quarters of federal marketplace consumers will be able to pay a monthly premium, which…

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Final OPPS Rule For 2017 Released By CMS

CMS has released their final rule for 2017 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. This rule implements site neutral payment options for the Bipartisan Budget Act of 2015. It is reported that CMS is implementing Section 603 of the Bipartisan Budget Act of 2015. Under the section, some of the…

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CMS Temporarily Stops Accepting Auto-Enrollment Proposals From Health Insurance Companies

The CMS has decided to temporary discard all new proposals from health insurance companies, who are seeking to enroll their Medicaid or commercial patients directly into their own Medicare Advantage plans. The federal agency stated that 29 Medicare Advantage companies which includes UnitedHealth Group, Aetna, and many other Blue Shield and Blue Cross insures can…

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AMA Offers Education And Online Tools To Cope With MACRA

The American Medical Association (AMA) recently released many online tools that are aimed to help physicians through pending Medicare payment and delivery changes. This will improve their opportunity for success under the new program that will come into effect in 2017. It is reported that the new online tools will help physicians in their preparation…

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HHS Reports Improper Medicare Claims From Chiropractors

A recent report issued by the Department of Health and Human Services (HHS) claims that the amount paid by the Medicare to chiropractors in 2013 for spinal manipulation was medically unnecessary. Reports indicate that approximately 82% (around $359 million) of the total $439 million Medicare reimbursement was for spinal manipulation. According to the HHS Office…

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ONC National Coordinator Analyzes Carequality Data Exchange

Health officials from Carequality, which is an initiative under the Sequoia Project, revealed that more than 150,000 clinicians, spread across 11,000 clinics, and five hundred hospitals, are live on their network. They said that the participants of the program are able to share health records and this can be done regardless of the vendor of…

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Advanced Alternative Payment Models For 2018 Revealed By CMS

The Centers for Medicare & Medicaid Services (CMS) recently announced new arrangements for payments that will be qualified as Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP) that is planned to start in the 2018 performance year. Those physicians and eligible clinicians who get some percent of revenue from the Advanced APMs…

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Study Claims CMS Has Higher Penalties For Readmissions Than For Mortality

An analysis conducted on publicly available hospital data revealed that the financial penalties for US hospitals in the year 2014 would have been considerably changed, if the Centers for Medicare and Medicaid Services had equally weighted mortality and 30-day readmissions. Researchers also pointed out that the financial penalties for readmissions under CMS are approximately 10…

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How To Avoid Negative Payment Adjustments Under MIPS

The Department of Health and Human Service recently issued the final rule for the Merit-based Incentive Payment System. Though it was received with mixed reviews, the final rule actually offers many ways to eligible clinicians to avoid negative payment adjustments under MIPS in the first reporting period. HHS also made it clear that they would…

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