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OIG report cites widespread MAO problems related to denials of care and payment. Medicare and Medicaid are moving steadily into a capitated model system – or should I say, “have moved.” A central concern about the capitated payment model used in Medicare Advantage is the financial incentive for Medicare Advantage…
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The Centers for Medicare & Medicaid Services (CMS) has informed state Medicaid directors that it intends to expand mental health treatment services via a new Medicaid demonstration project, the agency announced in a press release issued Tuesday. In a letter to the state Medicaid directors, CMS reportedly outlined existing and…
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Highlights of the 2019 Medicare Physician Fee Schedule, released on Nov. 1, are provided by the author. There will be no change in E&M payment levels for 2019, as was proposed in the Centers for Medicare & Medicaid Services (CMS) proposed, rule, news that comes as a relief to many…
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“Outpatient” does not equate “same-day.” By this time last year, the Centers for Medicare & Medicaid Services (CMS) had notified providers that they were removing total knee arthroplasty (TKA) from the Medicare inpatient-only list. While the cries of disbelief and howls of frustration eventually died down after a few months,…
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Plaintiffs are the American Hospital Association and three other regional hospitals and healthcare systems. Providers with Medicare appeals pending may have their claims resolved sooner than expected. On Nov. 1, 2018, U.S. District Court Judge Boasberg ruled that the U.S. Dept. of Health and Human Services (HHS) must eliminate the…
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CAR-T therapy could list a single service with a $1.4 million charge. I was honored to be able to speak at the annual meeting of the National Association of Healthcare Revenue Integrity in Arizona in mid-October. Since the audience was a group of hospital revenue staff, I used my session…
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More than a third of ACOs might leave if the proposed rule takes effect. The comment period closed for the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) proposed rule on Oct. 16. The MSSP has been a controversial program since its inception. The chief concern…
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The final rule on provider-based clinics is expected in early November. To understand changes being made relative to provider-based clinics, both Federal Registers must be read, and due to the complexity of the language, studied with care. Note that these are proposed rule changes. We will have to wait until…
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Chapter 8 changes appear to be less fair than ever before. “Life Isn’t Fair, but Government Must Be”— Former Texas Governor Ann Richards, 1991 Everyone has a plan until they get punched in the mouth, according to Mike Tyson, retired boxer and armchair philosopher. And it appears that the Centers…
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Many MAOs have overplayed the significance of this decision. On Sept. 7, in federal district court in Washington, D.C., in a case in which the Medicare Advantage Organizations (MAOs) in the UnitedHealth Group family of companies sued Alex Azar, the Secretary for the U.S. Department of Health and Human Services…