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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.

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.

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.

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%.

North Carolina wants to save $300M a year by pegging reimbursement to Medicare rates—but hospitals are pushing back

November 15, 2018


Hospitals in North Carolina are pushing back against a plan to tie what the state pays for workers' health care to Medicare's reimbursement rate—a move that hospitals say could jeopardize access to care.

CMS gives states more flexibility to cover inpatient mental health care

November 14, 2018


CMS under a new waiver will allow states to use federal funding to pay for up to 30 days of treatment for Medicaid beneficiaries being treated at institutions of mental disease primarily for a mental health condition.

93% of participants earned a MIPS bonus payment this year. (But it could be harder next year)

November 9, 2018


Ninety-three percent of clinicians eligible for MACRA's Merit-based Incentive Payment System received a bonus payment for the 2017 performance year, CMS Administrator Seema Verma announced in a blog post.

Mandatory payment models are making a comeback, Azar says

November 9, 2018


HHS Secretary Alex Azar says CMS' Center for Medicare & Medicaid Innovation plans to test a mandatory Medicare payment model for radiation oncology and new versions of two previously canceled payment models for cardiac care.

Appeals court denies insurers' request to rehear cases over ACA risk corridor payments

November 8, 2018


A full panel of judges for the U.S. Court of Appeals for the Federal Circuit has denied a request from four health insurers to rehear their cases claiming the federal government owes millions of dollars in risk corridors payments, and at least two of the insurers intend to appeal the case to the Supreme Court.

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