Medicare

Nursing homes blamed for high opt-out rates in dual eligible demo

Nursing homes blamed for high opt-out rates in dual eligible demo

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Huge numbers of dual-eligible beneficiaries are leaving a demonstration project that hopes to improve payments for people eligible for both Medicare and Medicaid.

Poorly coded doctor claims cost Medicare $33 million: OIG report

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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.

Fee-for-service still consumes most Medicare outlays: Report

Fee-for-service still consumes most Medicare outlays: Report

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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.

Obama sending mixed message on Medicare prescription prices

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.

Providers suffering Medicare appeals backlog — at their own hand?

Providers suffering Medicare appeals backlog — at their own hand?

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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.

Smart cards would do little to curtail Medicare fraud: GAO

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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.

Proposals to pay for 'doc fix' law are making long-term care providers nervous

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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.

What will it cost you to stay in the post-acute care game?

What will it cost you to stay in the post-acute care game?

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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.

Budget cut-hungry GOP walks fine line, eyeing 2016 elections

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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.

Average SNF patient paid $3,400 when ineligible for Medicare, AARP report finds

Average SNF patient paid $3,400 when ineligible for Medicare, AARP report finds

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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.

Avoiding fraud claims

Avoiding fraud claims

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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.

Christie calls for Medicare, Social Security cuts, greater state control of Medicaid

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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.

Nursing home operators hail 'historic' Senate passage of permanent 'doc fix' bill

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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.

CMS actuary throws cold water on 'doc fix' bill projections

CMS actuary throws cold water on 'doc fix' bill projections

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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.

CA man gets 30 months in prison, hefty fine in clinic 'fraud' case

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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.

Advocates: Cost-relief decision hurts Medicare beneficiaries

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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.

Medicare physician pay cuts officially kick in Wednesday

Medicare physician pay cuts officially kick in Wednesday

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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 get readmitted more often after joint replacement surgery: Study

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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.

Providers holding breath for Senate 'doc fix' vote

Providers holding breath for Senate 'doc fix' vote

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As expected, the House of Representatives on Thursday repealed the Medicare Sustainable Growth Rate (SGR), earning loud praise from the American Health Care Association.

Medicare providers could face up to 100% late tax penalties

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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.

Bill would credit observation stays toward 'three-night rule'

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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.

Nursing home groups support 'doc fix' bill

Nursing home groups support 'doc fix' bill

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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.

Joint HHS, Justice efforts recoup $28 billion in Medicare payments

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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.

Inspector General blasts agency for ignoring ZPIC scrutiny

Inspector General blasts agency for ignoring ZPIC scrutiny

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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.

Congress mulls Medicaid-Medicare pay parity, and end of 'doc fixes'

Congress mulls Medicaid-Medicare pay parity, and end of 'doc fixes'

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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.

Also in the News for Monday, March 9

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

Bill would cover telehealth

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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.

New Medicare ACO to be unveiled soon

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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.

'Observation status' provision under further review

'Observation status' provision under further review

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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.

RAC groups battle provider plea for short-stay payment relief

RAC groups battle provider plea for short-stay payment relief

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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.

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