This week’s healthcare news highlights details of the Centers for Medicare & Medicaid Services (CMS) new cardiac bundled payment program, how strong compliance programs may help deter healthcare fraud, Verisk Health’s appointment of Dr. Emad Rizk as chief executive officer and board director, and details of CMS’ final rule on a controversial 1.5 percent cut to hospital reimbursements.... Read More
The Centers for Medicare & Medicaid Services (CMS) released its 2015 Payment Transfer Report on June 30, 2016. Now that plans have had a chance to digest their results, we asked our in-house experts for insight on what plans should be considering as they prepare to begin submissions for benefit year 2016.
This week’s healthcare news highlights a recent report that outlines key insights for creating a more affordable healthcare system, details on health plans concerns over further participation in the health insurance marketplace, projections that Medicare is slated to save over $2 trillion over the next decade, and how employers can take action on a major healthcare cost driver.... Read More
This week’s healthcare news highlights what’s next for MACRA, a reported increase in medical services for those diagnosed with opioid dependence, the latest from the federal government on new penalties for readmissions, and Deloitte’s recently released Top 10 healthcare innovations list.... Read More
Each year, plans face new challenges in their HEDIS® reporting as NCQA updates its reporting requirements to account for any changes to the program. We find that among our clients, even the smallest changes can create big problems if appropriate steps aren’t taken in advance to accommodate updates. And while these challenges aren’t likely to go away any time soon, the good news is that NCQA reports that overall quality performance is up—and that HEDIS data continues to have a positive impact on other areas of reporting as well, such as CMS Five-Star quality ratings.... Read More
This week’s healthcare news highlights the recent bust of the United States’ largest healthcare fraud scheme to date, an update on the Centers for Medicare & Medicaid Services (CMS) recently released Five-Star ratings, how CMS is hoping to address hospitals’ growing concerns over bundled payments under MACRA, and the National Association of ACOs’ explanation of new reimbursement methods.... Read More
If you’ve ever purchased a bunk bed, swing set, or bicycle for your child, you likely recall the hours it took to progress from a neatly packaged box of parts to a finished product. The concept of “no assembly required” got us thinking a bit more about real-life, classic product assembly struggles and how they relate to everyday healthcare fraud, waste, and abuse (FWA) situations in which turnkey allegations could be helpful to special investigations units.
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This week’s healthcare news highlights growing concerns that compounded drugs create greater healthcare fraud opportunities, the announcement of a potential delay to MACRA, proposed new changes to HEDIS® measures in 2017, and the latest report on how ACOs can effectively help reduce healthcare costs through coordinated care.... Read More
As its beneficiary population continues to expand, the Medicare program faces persistent pressure to do more with less. With The Centers for Medicare & Medicaid Services (CMS) facing continual legislative and regulatory payment policies, along with significant program cuts, budgets are sure to further tighten across the program, potentially impacting benefits for individuals enrolled in Medicare Advantage (MA) programs.... Read More
This week’s healthcare news highlights President Obama’s call for a new public option in health law, the U.S. Department of Health and Human Services’ (HHS) efforts to help protect healthcare organizations against ransomware attacks, a look at why fraud laws might impede value-based care progress, and hospital groups’ concerns over the Centers for Medicare & Medicaid services (CMS) publishing its Five-Star ratings.... Read More