Huge numbers of dual-eligible beneficiaries are leaving a demonstration project that hopes to improve payments for people eligible for both Medicare and Medicaid.
The Health & Human Services' Inspector General is advising the agency to have its Medicare contractors chase down more than $33 million that might have been overpaid to physicians as a result of seemingly innocent coding errors for services.
Far more than half of the $360 billion in Medicare payments made just two years ago were based on traditional fee-for-service models without regard to quality or value, according to an independent report released Tuesday.
Prescription drug prices are likely to resurface as a hot political potato in the looming presidential race, beginning with the president's recent bombshell that he wants to let Medicare bargain on drug prices.
If providers were charged a fee for challenging Recovery Audit Contractor findings, there wouldn't be the current overwhelming backlog of Medicare appeals, says the administration — and, surprise, the auditors themselves.
Medicare beneficiary smart cards would have a limited impact on reducing fraud and could even introduce "new, more sophisticated fraud schemes," a new report by the Government Accountability Office concludes.
Much of last week's historic bill that created new payment rates for Medicare doctors was left unfunded by lawmakers, and now GOP budget hawks are presenting ideas that provoke anxiety in the sector.
More than just collecting data, providers need to use standardized, nationally recognized measures. Especially in this era of ACOs and alternative payment models. In the past, many individual providers used their own methodology to create their own "data driven" story.
House and Senate Republican lawmakers began working on a budget this week that could propose slashing Medicare and Medicaid in an effort to work toward a balanced budget without fiddling with tax rates, according to published reports.
New AARP research reveals that the use of hospital "observation" status is having a substantial impact on out-of-pocket healthcare costs and follow-up care decisions for many Medicare beneficiaries.
With Medicare and Medicaid costs soaring, federal and state agencies are looking at various avenues to rein in costs. Fraudulent billings from healthcare providers costs taxpayers millions of dollars each year and is an area of focus for government agencies.
Few things signal the fresh start of a presidential campaign season better than stump speeches calling for Medicare and Social Security cuts. And 2015 is no exception.
The Senate overwhelmingly voted to pass H.R. 2 Tuesday night, paving the way for repeal of the Medicare Sustainable Growth Rate and drawing the praise of the largest nursing home association in the country.
Long-term care leaders who have widely endorsed a House proposal to permanently "fix" the Sustainable Growth Rate formula, might be suffering buyer's remorse after learning Friday that the bill might not provide the lasting relief it promises. But they're still hopeful as the Senate reconvenes Monday.
A San Diego man will serve 2½ years in custody after being ordered to repay the government nearly $1 million for what prosecutors say were phony Medicare claims for medically unnecessary and unsupervised tests on unsuspecting seniors, the FBI reported.
After giving the ruling a few days to sink in, several patient advocate groups now say a Supreme Court decision will end up hurting Medicaid beneficiaries more than anyone.
The Centers for Medicare & Medicaid Services said it will hold physician claims for 14 calendar days, thereby delaying 21% rate cuts otherwise set to take effect Wednesday.
Non-whites covered by Medicaid and Medicare are significantly more likely to be readmitted to a hospital within 30 days after total joint replacement surgery than whites, according to a new study that was unveiled on Thursday at the 2015 Annual Meeting of American Academy of Orthopaedic Surgeons.
As expected, the House of Representatives on Thursday repealed the Medicare Sustainable Growth Rate (SGR), earning loud praise from the American Health Care Association.
Praise for Congress for proposing a bill that would reset Medicare physician pay rates could be a little less hearty, after details emerged Tuesday that the measure would also include penalties as high as 100% for providers delinquent with income tax payments.
A bill introduced in Congress on Monday would count all time that Medicare beneficiaries spend under hospital "observation" status toward the three-day inpatient requirement necessary to receive Medicare coverage for nursing home care.
Leaders of the nation's two largest long-term care associations spoke favorably Monday about a bill that would improve Medicare physician pay rates while moderately restricting LTC pay. In fact, the head the American Health Care Association said the group will "enthusiastically support" a bill that would end the "doc fix" issue, provided the final language is what it expects.
The Justice Department announced on Thursday it had captured $3.3 billion from healthcare fraud prosecutions and other deals in 2014, bringing to nearly $28 billion the total amount it has recouped since the beginning of its 18-year-old Health Care Fraud and Abuse Control (HCFAC) Program.
Ignoring a four-year-old warning to more thoroughly evaluate Medicare auditing contractors is among the pile of unheeded advice that could have saved the Medicare program billions of dollars in recent years, the Health and Human Services' Office of Inspector General charged Tuesday.
Long-term care providers are closely monitoring two major lawmaking efforts in Washington this week that have both chambers of Congress debating a plan to end annual Medicare cuts and abolish painful "fixes" to the Medicare physician payment formula.
GAO: Medicare paid billions wrong in 2014 ... Proposal would mean $6K more per year for private pay nursing home residents, group says ... Contracted nursing aide accused of sexual assault at facility had prior convictions
In a move that could greatly expand the visibility and adoption of telehealth systems, Congress is proposing that Medicare reimburse telehealth services at the same rate as in-person medical visits.
The government's top health insurer has announced that providers could get a first look at a new type of Medicare accountable care organization this month. It has been modeled closely after a controversial managed care program and includes new waivers for skilled nursing facilities.
The American Health Care Association on Thursday applauded a House measure that would inform Medicare beneficiaries of their observation status as hospital inpatient or outpatients. But that might be little consolation for skilled nursing facilities that face the prospect of not getting reimbursed after such observation periods.
Third-party firms that audit Medicare bills for payment issues are pushing back hard against a hospital association plea for more favorable short-stay reimbursements, adding to the ongoing unwelcome specter of audits among all providers, including those in long-term care.