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Healthcare Industry News

CMS cancels earlier edits to Medicare billing for partial hospitalizations

Aug 2017 – CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services over concerns that the proposed edits would substantially increase the administrative burden on providers. The earlier ruling mandated providers to furnish a minimum of 20 hours per week of therapeutic services and to submit bills weekly. Click here to read more.

CMS seeks more oversight over Medicare Advantage provider networks

July 2017 – The CMS wants the plans to upload their networks to a central federal database for review if they haven’t undergone an entire CMS network review in the previous three years. According to CMS this would provide “timely compliance monitoring.” The CMS would review provider information annually to make sure the payers are complying. Click here to read more.

CMS’ map shows 47 counties without an insurer in the exchange market

June 2017 – A federal map of payer participation in the health insurance exchanges shows 47 counties nationwide are projected to have no insurers for 2018. Currently, at least 35,000 active exchange participants live in the counties projected to be without coverage in 2018, and roughly 2.4 million are projected to have one issuer, CMS said. Click here to read more.

Inovaare announces the release of its new User Interface, for improved mobility within all its products

Inovaare announces the release of its new User Interface, making mobility within all its products even simpler and more functional, allowing users to access needed elements at every step. Click here to know more.

GAO Report: Medicare High Risk Issue

In 2016, Medicare was projected to cover approximately 57 million people with estimated expenditures of about $696 billion. The Centers for Medicare & Medicaid Services (CMS), which administers Medicare, faces many challenges related to implementing payment methods that encourage efficient service delivery including implementing changes to payment models outlined in the Patient Protection and Affordable Care Act and the Medicare Access and CHIP Reauthorization Act of 2015, managing the program to serve beneficiaries well, and safeguarding the program from loss due to fraud, waste, and abuse.

The three Key approach to this issue will be:

  • Reforming and refining payment methods to encourage efficient service delivery
  • Improving program management for efficiency and better service to beneficiaries
  • Enhancing program integrity to safeguard Medicare from loss

For details check out the report written by the US Government Accountability Office
http://www.gao.gov/key_issues/medicare_payment_management_integrity/issue_summary

Inovaare Among Top 100 Silicon Valley Start-ups

There is no doubt that the Indian diaspora has been a great contributor towards the technology evolution in the U.S. Out of nearly 20,000 Silicon Valley start-ups, 25 percent are run by Indians. This also shows that the compelling rise in the technological evolution is being greatly received and addressed by the young Indian entrepreneurs. Be it IoT, or the all pervasive cloud technology, or the accelerating pace of Big Data adoption which is a great promise to solving some of the world’s most complex issues, it is greatly encouraging to see all these falling within the purview of the Indian entrepreneurial diaspora.

Click here to know more about the Top 100 Silicon Valley start-ups. http://www.siliconindia.com/magazine_articles/Top_100_Tech_Companies_Founded_and_Managed_by_Indians_in_the_US-WGAR554925450.html

GAO Report: Medicare Advantage – Actions Needed to Enhance CMS Oversight of Provider Network Adequacy

On September 28, 2015, the Government Accountability Office (GAO) released a report. In this GAO Recommends,
the Administrator of CMS should augment oversight of MA networks to address provider availability, verify provider information submitted by MAOs, conduct more periodic reviews of MAO network information, and set minimum information requirements for MAO enrollee notification letters.

The GAO Report is available here.

CMS awards $110 mn in Affordable Care Act funding

CMS awards $110 million in Affordable Care Act funding to continue improvements in patient safety

Centers for Medicare & Medicaid Services (CMS) awarded $110 million in Affordable Care Act funding to 17 national, regional, or state hospital associations and health system organizations to continue efforts in reducing preventable hospital-acquired conditions and re-admissions. Through the Partnership for Patients initiative – a nationwide public-private collaboration that began in 2011 to reduce preventable hospital-acquired conditions by 40 percent and 30-day re-admissions by 20 percent – the second round of the Hospital Engagement Networks will continue to work to improve patient care in the hospital setting.

Click here to read more

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-09-25.html

 

CMS releases 2014-24 Projections of National Health Expenditures Data

CMS released 2014-24 Projections of National Health Expenditures Data

In 2014, health spending in the United States is projected to have reached $3.1 trillion, or $9,695 per person, and to have increased by 5.5 percent from the previous year as millions gained health insurance coverage and as new expensive specialty drugs hit the market. Prescription drug spending alone increased 12.6 percent in 2014, the highest growth since 2002. While more people are getting coverage, annual growth in per-enrollee expenditures in 2014 for private health insurance (5.4 percent), Medicare (2.7 percent) and Medicaid (-0.8 percent) remained slow in historical terms.

For full details read: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-07-28-2.html

CMS saves $820 mn in inappropriate Medicare payments

Date 2015-07-14

CMS cutting-edge technology identifies & prevents $820 million in inappropriate Medicare payments in first three years

After three years of operations, the Centers for Medicare & Medicaid Services (CMS) today reported that the agency’s advanced analytics system, called the Fraud Prevention System, identified or prevented $820 million in inappropriate Medicare payments in the program’s first three years. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for action, similar to systems used by credit card companies.  The Fraud Prevention System identified or prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on investment.

Read more: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-07-14.html

Affordable Care Act payment model saves more than $25 million

Affordable Care Act payment model saves more than $25 million in first performance year

Read the CMS Press release here https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-18.html

CMS Open Payments posts full year of 2014 financial data

The Centers for Medicare & Medicaid Services (CMS) today published 2014 CMS Open Payments data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.

Click here for more details. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-30.html

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