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Hospitals are suing to block Medicare's site-neutral payments

December 5, 2018


The American Hospital Association, the Association of American Medical College, and three independent health systems in a lawsuit argue that the Trump administration does not have the authority to implement a new site-neutral payment policy under Medicare.

Nearly 11,000 SNFs will receive Medicare penalties under new VBP program

December 5, 2018


CMS data show nearly 11,000 skilled nursing facilities will see their Medicare payments decrease in fiscal year 2019 as a result of poor performance under CMS' new Skilled Nursing Facility Value-based Purchasing Program.

How nearly 3,000 hospitals fared on VBP penalties, bonuses for FY 2019

December 4, 2018


CMS says more than 1,500 U.S. hospitals will receive bonus payments in fiscal year 2019 under Medicare's Value-Based Purchasing Program.

HHS finalizes long-awaited 340B rule

November 30, 2018


HHS has finalized a long-delayed ceiling price and civil monetary penalties rule for Medicare's 340B drug discount program that is slated to take effect Jan. 1, 2019.

How much is that surgery? CMS' new Medicare price tool might have the answer.

November 29, 2018


CMS' new online tool shows the national average that Medicare pays both ambulatory surgical centers and hospitals for certain procedures, as well as the national average copayment a Medicare beneficiary without supplemental insurance would pay for the procedures.

Flawed data led to $140M in Medicare hospital overpayments, according to HHS' OIG

November 29, 2018


HHS' Office of the Inspector General in a new report identifies "material inaccuracies" in data CMS used to calculate the Medicare Area Wage Index, which the agency uses to adjust hospitals' Medicare payments.

Inside CMS' plan to lower drug costs for Medicare Part D enrollees

November 28, 2018


CMS' proposed rule seeks to eliminate barriers that prevent Medicare Part D and Medicare Advantage enrollees from accessing lower-cost drugs by giving Part D plans more flexibility to use formulary management tools, such as prior authorizations and step therapy.

How providers want Medicare to ease its anti-kickback laws (and what it means for value-based care)

November 27, 2018


Earlier this year, the Trump administration asked for recommendations on ways to ease anti-kickback laws that limits where physicians can refer Medicare beneficiaries. Providers and lobbying groups responded in force—but some legal experts say any move to ease existing laws could increase fraud and abuse.

Amid epidemic, opioid reversal drug saw a 600% price surge, Senate report finds

November 21, 2018


A report from the Senate's Permanent Subcommittee on Investigations found the price of EVZIO, a drug designed to reverse an opioid drug-related overdose, increased from $575 per unit in 2014 to $4,100 per unit in 2017.

Improper Medicare payments fall to record low, CMS says

November 20, 2018


CMS says the 2018 Medicare Fee-For-Service (FFS) improper payment rate decreased from 9.51% in fiscal year (FY) 2017 to 8.12% in FY 2018, marking the second consecutive year the agency's improper Medicare FFS payment rate is less than 10%.

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