The CMS is canceling two mandatory cardiac pay models that were supposed to start next year and is scaling back a joint replacement model that has already been implemented by hospitals across the country.
Facing a crushing caseload of appeals to denied Medicare claims, the CMS is launching a new audit process to reduce the number of providers that have their claims challenged.
Providers increasingly are conducting advance care planning conversations with Medicare beneficiaries thanks to new CMS billing codes and a push to prepare early for patients' final days. The trend resulted in them drawing down $93 million in additional revenue last year.
When the 21st Century Cures Act last year included a provision requiring Medicare to account for patient backgrounds when it calculated hospital readmission penalties, safety net providers rejoiced.
A fast-growing Chicago company that provides primary care for the elderly has inked what could be a lucrative deal to join Aetna's Medicare Advantage network.
The 60-year-old Dallas-area doctor and six co-defendants defrauded Medicare and Medicaid out of almost $375 million by certifying 11,000 Medicare beneficiaries through home health providers. Their numbers would have made the doctor's Medicare practice the busiest in the country.
The Trump administration has placed a one-year moratorium on the so-called 25% rule, and hospitals hope it signals the end of a looming budget cut that they've been fighting for years.
The controversial competitive bidding program saved the CMS $26 billion over 10 years. Yet, similar savings could be obtained through a market-based approach, a new study found.
A sizable number of Americans eligible for premium subsidies are passing them up by buying health insurance outside the Affordable Care Act's insurance exchanges. That could be affecting the health of the individual insurance market, particularly to the extent people are buying plans that do not...
Insurers are grappling with how to manage their government and individual lines of business, with mixed results.
Many orthopedic surgeons and ambulatory surgery center operators are delighted with the CMS' mid-July announcement that it's considering paying for total knee and hip replacement procedures in outpatient settings. But lots of hospital leaders are not.
Some hospitals and health systems have acquired ambulatory surgery centers or formed joint ventures with surgeons, allowing hospitals to keep a piece of the revenue.