Balance Billing Excluded For Medicare Beneficiaries Under QMB

In latest news, CMS expressed their concern regarding physicians billing Medicare beneficiaries registered with the Qualified Medicare Beneficiary (QMB) program. The QMB initiative is targeted for dual-eligible beneficiaries with very low income, who are registered to both Medicare and Medicaid with the cost-sharing plans offered by Medicare. Nevertheless, many of the beneficiaries are unaware of…

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Supreme Court Ruling Clarifies Scope Of False Claims Act Liability

The US Supreme Court recently issued an undisputed decision on the Universal Health Services v. Escobar case that has great implications for upcoming False Claim Act (FCA) cases. The Court also ruled that the same theory for FCA liability could be implemented for proving the non-compliance of an institution. Besides that, an exceptional materiality standard…

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OIG Conducts Study On Provider-Based Requirements

The Office of the Inspector General, HHS recently published a report on off-campus units that were covered under Medicare as provider-based facilities. OIG conducted a study to make sure that only those facilities that meet the CMS requirements receive the provider-based reimbursements. For a facility to be eligible as a provider-based unit, it should be…

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CMS Proposal Could Be The Key To Relieve ALJ’s Workload

Recently, CMS proposed a few changes to the “…procedures that the Department of Health and Human Services would follow at the Administrative Law Judge level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage and other Medicare competitive health plans, and enrollees in Medicare prescription…

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Medicare Trust Fund Reports On HI And SMI

The Medical Trustees recently released their annual report on the Hospital Insurance (HI) trust fund and the Supplementary Medical Insurance (SMI) trust fund. The Medicare program covered around 55.3 million individuals last year; among which, 32% were enrolled for Medicare Advantage plan. Around 44.3 million individuals under the plan were above the age of 65,…

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Will CMS’s Bold Move Be Effective In Limiting Medicine Cost?

The Center for Medicare & Medicaid Services recently proposed a new approach towards Medicare Part B payment, which aims to control how prescription drug cost determines the payment of physicians. This could also reduce the percentage of coinsurance payment that is currently up to 20%. Under the current plan, payment for physician by Medicare Part…

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Oncology Care Model Aims To Reduce Cancer Cost – CMS

The Centers for Medicare & Medicaid Services recently announced that 196 practices would be participating in their proposed Oncology Care Model (OCM). CMS says that OCM is designed to decrease the expenditure for oncology without compromising on quality of care. In view of that, Sylvia M. Burwell, Secretary of Health and Human Services said “…the…

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HHS To Employ Ethical Hacking Programs For Detecting Security Holes In Health IT

The immense success of DoD’s “Hack the Pentagon” program has grabbed the attention of Department of Health and Human Services. The recently completed program was able to determine the cyber vulnerabilities in the Department of Defense and the hackers who were able to find out these vulnerabilities were rewarded. HHS believes that this ethical hacking…

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Healthcare In US Threatened By Zika Virus

The Zika Virus, as we know, can infect a person via a mosquito bite and lead to serious health issues such as dengue, fever, conjunctivitis, pain in the muscles and joints, depression, and headache. However, the Centers for Disease Control and Prevention (CDC) recently said that if infected during pregnancy, the Zika Virus could cause…

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Congress Tries To Pass Opioid Addiction And Abuse Bill

This is an election year for America and the expectations of Congress passing legislations are high. But against the expectations, Congress is willing to pass a bill that addresses the increasing addiction to opioid products and their abuse. In fact, this has become a serious issue in many parts of the country. Addiction to opioid…

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