Medicare Advantage should not 'game the system' but prioritize patient care, honest billing

The HHS Office of Inspector General's principal deputy warns, "My office and other government agencies are targeting oversight to make sure plans do not pad risk adjustments with unsupported diagnoses."

By Christi A. Grimm • Sept. 23, 2020

Payers, other stakeholders urge Congress to blunt COVID-19-spurred insurance losses

"The odds are we are on track to having the greatest coverage losses we've ever recorded," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, said during a briefing Tuesday.

By Samantha Liss • Sept. 23, 2020

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Surprise Billing

Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.

By Healthcare Dive staff

CMS to expand ambulance prior authorization model nationwide

The model saved Medicare about $650 million in four years without changing care quality or access. However, the timeline for its rollout is still to be determined amid COVID-19 uncertainty.

By Rebecca Pifer Parduhn • Sept. 23, 2020

Georgia practice to pay $1.5M after hacker accessed thousands of patient records

The group calling itself The Dark Overlord used a vendor's credentials and attempted to sell the data, including medical procedures and other personal information, online.

By Shannon Muchmore • Sept. 22, 2020

CMS to push back radiation oncology model after industry blowback

Agency administrator Seema Verma said the upcoming rulemaking will formalize a 6-month delay because "more time is needed to prepare."

By Susan Kelly • Updated Oct. 22, 2020

Hospitals charge privately insured patients 250% more than those on Medicare. The gap is growing.

A RAND study of charge data from more than 3,000 hospitals points the finger at growing provider consolidation as a key culprit, but the AHA slammed the report as "based on a cherry-picked and limited dataset."

By Ron Shinkman • Sept. 18, 2020

Trump admin unveils final mandatory kidney care payment model

Forced participation in the ESRD model, where CMS will identify providers in randomly selected regions to take part, drew industry ire when it was first proposed one year ago.

By Samantha Liss • Sept. 18, 2020

'We feel bullish': Payers look ahead to 2021

Top execs at the biggest commercial insurers outlined shifting strategic priorities and growth opportunities in light of the COVID-19 recession at Morgan Stanley's annual healthcare conference last week.

By Rebecca Pifer Parduhn • Sept. 17, 2020

CMS innovation agency to launch risk-based model for dual eligibles

Along with the dual-eligible demonstration, CMMI head Brad Smith said Tuesday industry could expect some additional models to come out of the pipeline in the next few months.

By Rebecca Pifer Parduhn • Sept. 16, 2020

OCR settles with 5 more providers on HIPAA right of access violations

Three of the providers failed to give the patient medical records access until after a second complaint to the HHS Office of Civil Rights was submitted and validated.

By Shannon Muchmore • Sept. 16, 2020

Uninsured rate rose to 9.2% in US last year, pre-COVID-19 recession

The high cost of U.S. healthcare continues to stress the country's economic outlook overall. About 7.7 million more Americans would be considered low-income if their medical bills were factored in, the U.S. Census Bureau said.

By Rebecca Pifer Parduhn • Sept. 16, 2020

FTC urges Texas regulators to block merger under COPA

The agency was blistering in its comments, warning regulators the deal would result in serious competitive and consumer harm in the form of higher prices, lower quality and diminished access to care and innovation.

By Samantha Liss • Sept. 15, 2020

CMS to ax inpatient data in MA risk scoring by 2022

The proposed changes should be a net positive for Medicare Advantage players, resulting in a 0.25% rise in risk scores.

By Rebecca Pifer Parduhn • Sept. 15, 2020

OSHA fines 3 hospital systems for PPE violations

Bergen New Bridge Medical Center said Monday afternoon it had not received the OSHA report but will "respond accordingly" when it does. The other two hospitals have not responded to requests for comment.

By Ron Shinkman • Updated Sept. 15, 2020

CMS kills controversial Medicaid fiscal accountability rule

The rule proposed last year would have increased federal oversight of how states fund their Medicaid programs and potentially resulted in funding cuts for the cash-strapped program. Providers strongly opposed it.

By Rebecca Pifer Parduhn • Sept. 14, 2020

Trump releases long-awaited drug pricing order, but its effects are likely far off

The White House disclosed details of an order to cut Medicare prices to international rates, but the proposed plan will be difficult to carry out and could take months to enact.

By Jonathan Gardner • Sept. 14, 2020

Fitbit receives FDA clearance for ECG app

The wearables giant has trailed rivals in product development and approval in the heart rhythm tracking arena. The nod brings it up to speed with Apple and Samsung.

By Rebecca Pifer Parduhn • Sept. 14, 2020

OIG says $2.6B paid out under MA risk adjustment with scant encounter data

The watchdog's analysis also found health risk assessments were taking place at a patient's home, and were often conducted by providers contracted by the health plan instead of their actual physician.

By Ron Shinkman • Sept. 11, 2020

Hospice respite flexibility is recipe for more patient protection

The CEO of the National Hospice and Palliative Care Organization writes in support of a bill that would allow respite care to be provided outside of inpatient settings and hospice patients to receive up to 15 days of respite care.

By Edo Banach • Sept. 9, 2020

Hospitals urge HHS to step in on 340B fight with drug manufacturers

On Friday, more than 1,100 hospitals sent another letter to HHS urging it to take action against drug manufacturers limiting drug distribution to 340B facilities.

By Shannon Muchmore • Updated Sept. 11, 2020

Medicaid enrollment has jumped 4.3M since February, could grow much more

By contrast, between February and August of last year, Medicaid enrollment averaged a decrease of 0.7% among all states, a report from Families USA found.

By Ron Shinkman • Sept. 8, 2020

MedPAC commissioners hint at telehealth policies that may stick post-COVID-19

"Pandora's box is open," Commissioner Susan Thompson, interim CEO of UnityPoint Health, said Friday, urging the group to embrace the moment.

By Samantha Liss • Sept. 8, 2020

Doctors affiliated with health systems have much higher MIPS scores, JAMA study finds

A separate study found that physicians who had the highest proportion of patients dually eligible for Medicare and Medicaid also had significantly lower performance scores than other doctors.

By Shannon Muchmore • Sept. 8, 2020

HHS issues plan to improve rural health, leaning on telehealth

But the Trump administration's lengthy plan falls short of a complete overhaul, citing relatively small funding increases and a fair amount of initiatives already in place.

By Ron Shinkman • Sept. 4, 2020

Federal COVID-19 cash saved most hospitals from bleakest forecasts: MedPAC

But any new congressional relief is stalled in Congress, and an HCA official warned cost-cutting initiatives that helped operators aren't sustainable.

By Rebecca Pifer Parduhn • Sept. 4, 2020