Tags » Medicare/medicaid

Medicare/Medicaid News - 08/08/14

HHS Agency Substantiates Watchdog Claim Of Rampant “Upcoding” in Medicare Advantage.
Fred Shulte of the Center for Public Integrity (8/7) reports on an investigation conducted by the Department of Health and Human Services Agency for Healthcare Research and Quality, which found that “Medicare made nearly $70 billion in ‘improper’ payments — mostly overcharges from inflated risk scores — to Medicare Advantage plans from 2008 through 2013 alone.” The Center for Public Integrity conducted an earlier investigation that uncovered the same billing inconsistencies, but also found that “risk scores rose much faster in some health plans than others and that federal officials repeatedly yielded to industry pressure to minimize efforts to recoup overpayments.” These overcharges are referred to as “upcoding.” 175 more words


Medicare/Medicaid News – 07/21/14

Some Seniors To Be Exempt From Medicare Three-Day Rule As Part Of Pilot Study.

The Washington Post (7/20, Jaffe) reported that some seniors will be exempt from the “controversial requirement that seniors be admitted to the hospital for at least three days to qualify for follow-up skilled nursing home care.” This waiver of the three-day rule, which is part of a pilot program aiming to test ways in which to develop better care at a lower cost, “applies even to patients kept for observation, which is considered an outpatient service. 77 more words


Medicare/Medicaid News - 07/16/14

States Respond To CMS Letter About Medicaid Enrollment Backlogs.
The Los Angeles Times (7/15, Brown) reports that California state health officials have responded to CMS’s June 27 request for a plan to address Medicaid enrollment issues and have pledged to “reduce the number of Medi-Cal applications it has pending under Obamacare by nearly half within six weeks.” The letter detailing the state’s plan to clear the backlog “focuses on fixing the computer troubles that have made it difficult for county eligibility workers to interface with CalHEERS, the state’s new healthcare enrollment system” as well as plans to “‘proactively inform consumers’ caught in the backlog by sending them letters with instructions on how to obtain care while they await their Medi-Cal cards.” 109 more words


Senate Committee Blasts CMS For Failing To Prevent Improper Medicare Payments.

 The Hill (7/10, Al-faruque) reports that the Senate Special Committee on Aging on Wednesday “blasted” CMS “for failing to prevent record-high improper payments and for putting undue burden on falsely accused providers.” Committee chairman Bill Nelson (D-FL), said, “The bottom line is, despite doing more audits than ever before, Medicare just isn’t getting the job done when it comes to preventing payment errors. 36 more words


CMS Proposes Rule Change for Home Health Services.

The Hill (7/2, Al-faruque) reports that in an effort for the Centers for Medicare and Medicaid Services (CMS) to save money, the agency plans on “toughening requirements for eligibility for home health services setting a minimum requirement on home health agencies to prove their effectiveness and revising how much CMS pays for certain services.” The Hill notes that the agency predicts this rule change will reduce costs by 0.30%, or $58 million, by 2015.