As the healthcare industry continues to evolve, the Center for Medicare and Medicaid Services (CMS) has proposed five changes for the Patient Protection and Affordable Care Act. The proposed changes are focused on: Risk Adjustment, Network Adequacy, Out-of-Pocket Maximums, Standardized…
The Center for Medicare and Medicaid Services (CMS) released the first set of “Core Quality Measures” this Tuesday, in which CMS and private payers agree to utilize in value-based payments. The collaborative includes members from America’s Health Insurance Plans (AHIP),…
By Lisa Schencker | January 23, 2016 Dr. Mark Monteferrante didn’t think it would be so hard to help his radiology group’s office in Northern Virginia buy a second MRI machine in 2003. But it took five years and more than…
Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket costs drop significantly under a federal proposal to create standardized plans, a recent analysis found. The government wants to create six plan options at…
TAKE ACTION & GET INVOLVED Contact your legislators! It makes a difference when you contact your Representatives and Senators early in the session. Discuss the issues that are important to your practice, your patients, and your community. The…
The Centers for Medicare and Medicaid Services on Monday proposed new rules to discharge planning requirements for long-term care hospitals, inpatient rehabilitation facilities, critical access hospitals and home health agencies. Under the proposed rule, hospitals and critical access hospitals…
With healthcare reimbursement quickly evolving to primarily a value-based model, many physicians fear the inevitable repercussions of not being prepared for contracting based upon patient outcomes. The unveiling of CMS’ Value-Based Modifier, the general market movement since the Affordable Care Act, the…
Since 1965, a lot has changed in the world of Healthcare policy. Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families. Since 1986, the Center…
The Government Accountability Office recommends that Congress removes the financial incentives the government pays hospitals as part of the 340B drug program. The GAO is concerned that this financial encouragement results in over-prescribing of medications at Disproportionate Share Hospitals (DSHs),…
Since their inception, narrow networks have been expanding due to consumers being increasingly willing to have reduced provider choices in exchange for lower premiums. Insurance companies are able to keep the premium lower by taking out high-cost employers. In addition,…