California's health insurance rates for a new state-run marketplace came in lower than expected this week, but one downside for many consumers will be far fewer doctors and hospitals to choose from. People who want UCLA Medical Center and its doctors in their health...
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Reimbursement
CMS Issues more In-Depth Survey Guidelines to Reduce Readmissions
The Centers for Medicare & Medicaid Services has revised the provider certification manual for hospitals, giving more in-depth guidelines around discharge planning. The goal is for hospitals to reduce readmissions by partnering with post-acute providers. The...
Did CMS Break Rules to Rig Bid Numbers?
Anybody who is paying any attention to the Medicare competitive bidding program understands that the program is fatally flawed. We all know that just about every qualified expert in the field of auction design has agreed that the program breaks just about every rule...
Industry Casts Further Doubt on Bid Process
H.R. 1717 remains the HME industry’s No. 1 priority, but with time running out, stakeholders are again pressing for a delay in the July 1 start date of Round 2 of competitive bidding. The basis for that delay: a growing list of contract suppliers that appear to fail...
Tennessee Congressional Delegation Question Legality of Competitive Bidding
Members of the Tennessee United States Congressional delegation today called on the administration "to provide details on its policy of awarding Medicare contracts to businesses not licensed in Tennessee, a violation of the administration’s bid policy and a violation...
Senators Introduce CRT Bill
WASHINGTON – Industry stakeholders now have bills in both the House of Representatives and the Senate to create a separate benefit for complex rehab technology (CRT). Sens. Chuck Schumer, D-N.Y., and Thad Cochran, R-Miss., introduced S. 948, the “Ensuring Access To...
CMS: Medicaid Disproportionate Share Hospital Allotment Payment Reductions
The Centers for Medicare & Medicaid Services (CMS) put on display at the Federal Register a Notice of Proposed Rulemaking titled “Medicaid Disproportionate Share Hospital Allotment Payment Reductions” (CMS-2367-P.) The Affordable Care Act requires...
Deadline Approaching for Competitive Bidding Grandfathering Notification
The Centers for Medicare & Medicaid Services (CMS) states: “Non-contract suppliers must provide written notification of their decision whether to be a grandfathered supplier to all of their Medicare beneficiaries who reside in a competitive bidding area (CBA) and...
Inconsistency in Hospital Charges Alarming
The White House administration revealed what over 3,000 hospitals charge for common medical procedures in an early effort to challenge healthcare costs by showing consumers how prices for the same service can vary by tens of thousands of dollars. The most extensive...
CMS Adjusts HCPCS Codes
The Centers for Medicare & Medicaid Services (CMS) have announced the scheduled release of adjustments to the Healthcare Common Procedure Coding System (HCPCS) code set. The changes can be found on the CMS website www.cms.gov. Changes are effective on the date...
Insurer and Michigan Hospitals Switch Reimbursement Plan
Michigan's largest health insurer and a dozen hospitals announced Monday they are starting to carry out a cost-saving deal designed to prevent unnecessary or overused tests and procedures, an attempt to put less emphasis on the traditional way providers are reimbursed...
CMS Delays PECOS Phase 2 Implementation
On Thursday April 25th, 2013 CMS Announced that due to Technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed. The edits would have checked the following claims for an approved or validly opted-out physician or...