CMS Stretches RAC Program To Benefit Medicare

There are heavy controversies surrounding the tactics used by the RAC audits to date. But despite this, they have been instrumental in saving Medicare significant money through the audits of Medicare Part A and Medicare Part B claims. In the year 2014, RAC returned $2.57 billion dollars in “improper payments” to the Medicare program. The…

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ACA CO-OPs Meets State Finance Committee To Discuss Challenges In Health Insurance Sector

ACA has led to numerous changes in the healthcare industry, but its key agenda is to bring about a progressive reform in the healthcare sector. Lately, the Senate Finance Committee conducted a meeting to analyze the issues faced by health insurance CO-OPs formed under the Affordable Care Act. The sole witness of the meeting was…

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Top Insurance Companies Plan To Leave AHIP

America’s Health Insurance Plan (AHIP) is the biggest lobbying group in the health insurance industry in USA. It is reported that most of the leading healthcare insurance companies in America are members of this group. However, recent reports indicate that some of the insurance companies are leaving this group. The first one to leave AHIP…

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MACRA Urges Participation In APMs Over MIPS

The administration is certainly laying out a plan for the post-SGR period. With the Medicare Access and CHIP Reauthorization Act of 2015 passed, the Medicare program will be moving towards two new payment systems by year 2019. Of these systems, the Merit-based Incentive Payment System (MIPS) mixes the current three Medicare quality programs inside a…

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Bill To Cancel Affordable Care Act Vetoed By The President

The Affordable Care Act was enacted in 2010 and it is highly regarded as the signature piece of legislation under Obama Administration. Nevertheless, the Republicans in America have been trying feverishly to replace this act. Since the enactment, there have been numerous voting at the House of Representatives to replace or delay the act. Interestingly,…

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CMS Launches The Final Rule For Prior Authorization

On December 29, CMS published a final rule finalizing a prior authorization process for specific durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), which are frequently seen by the agency as utilized unnecessarily. The final rule CMS put out says the authorization process will require the same information as is required to support Medicare payment.…

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CMS To Adopt Testing Care Model

In a recent report, CMS said that it was going to adopt a new community based healthcare program for testing. The purpose of the testing is to see how the screening of Medicare and Medicaid beneficiaries will help improve healthcare system. It will also see whether this will help bring about any cost cutting in…

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Enrollment In ACA Proceeds With A Surge

Following a strong start, enrollment in the QHPs sold at Health Insurance Exchanges set up under the ACA has fared vitally. As of December 2015, over 8.3 million people have signed up for health insurance through these exchanges. Meanwhile, 6.4 million people registered through healthcare.gov website the year before. Enrollment goals set by the administration…

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CMS Confirms Mandatory Medicare Bundled-Pay For Joint Replacement Surgery

CMS finalized the proposed bundle payment system for its hip and knee replacement surgery known as the CCJR model on November 16. Even though the final rule makes some changes to the model, which was proposed at the start, by reducing the number of participating metropolitan statistical regions from 75 to 67, over 800 hospitals…

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2016 Open Enrolment Period Has Ended

The 2016 open enrollment period for health insurance plans sold in HIEs has officially ended. With this over now, information is starting to flow in towards the third open enrollment period. In the middle of January, HHs had announced that 8.9 million customers have signed up for health-coverage using the HealthCare.gov platform or had their…

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