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CMS' 2020 MPFS proposed rule draws more than 40,000 comments

October 1, 2019


CMS' public comment period for the 2020 Medicare Physician Fee Schedule proposed rule ended last week, and the agency received more than 40,000 comments from hospital groups, insurers, and other industry stakeholders.

Do value-based payment programs work?

October 1, 2019


Medicare has increasingly emphasized value-based payment programs since the Affordable Care Act's enactment, but nearly a decade later, experts are still weighing whether these value-based initiatives work, health economist Austin Frakt writes for the New York Times' "The Upshot."

DOJ charges 35 individuals in $2B Medicare scam

October 1, 2019


The Department of Justice last week announced that it has brought charges against 35 individuals, including 10 medical professionals, for their alleged role in a Medicare scam involving dozens of telemedicine companies and genetic testing laboratories.

Insurers are testing bundled payment models for maternity care. Are OB-GYNs on board?

September 30, 2019


Payers are testing bundled payments in maternity care as a way to reduce costs and improve outcomes, and while some obstetricians say the accountability is overdue, others are worried that the payment mechanism exposes them to financial risk unfairly.

Hospitals will see $4B DSH payment cut in 2020 under CMS rule

September 25, 2019


CMS this week finalized a rule outlining how it will calculate annual Medicaid disproportionate share hospital payment cuts from fiscal year (FY) 2020 through FY 2025.

The House’s 'surprise bill' fix could cut provider payments by up to 20%, CBO finds

September 24, 2019


The House Energy and Commerce Committee's bill to address so-called "surprise" medical bills would reduce in-network provider payment rates and premiums in some markets and generate $21.9 billion in federal savings over a decade, according to a Congressional Budget Office report released last week.

Pelosi unveils bill to lower Rx drug prices. But will it pass Congress?

September 20, 2019


House Speaker Nancy Pelosi (D-Calif.) on Thursday unveiled a highly anticipated bill that aims to reduce prescription drug prices in the United States by giving the HHS secretary the authority to negotiate Medicare payments for certain drugs and establishing a drug price ceiling for the negotiations based on the prices paid for the drugs in other countries.

Inside Buttigieg's 'Medicare for All Who Want It' plan

September 19, 2019


South Bend, Indiana, Mayor Pete Buttigieg (D), who is seeking the 2020 Democratic nomination for president, on Thursday released his so-called "Medicare for All Who Want It" plan, which would create a public health plan that Americans could choose to opt in to.

Tennessee has a first-in-the-nation plan to convert Medicaid into a block grant

September 19, 2019


Tennessee on Tuesday released a draft Medicaid waiver proposal to convert the state's Medicaid financing structure from an open-ended federal funding system into a block-grant system.

Providers urge CMS to delay proposed radiation oncology bundled payment model

September 19, 2019


Provider groups are urging CMS to delay its proposed mandatory bundled payment model for radiation oncology, saying the model could lower investments in new technologies and equipment and reduce access to new types of care.

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