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CMS finalizes rule on 2018 risk-adjustment payments

December 10, 2018


CMS under a new rule will "adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year," which bases such payments on statewide average premiums.

Despite 'glimmers of stability,' Moody's predicts worsening financial outlook for nonprofit hospitals

December 10, 2018


Nonprofit hospitals will continue to see expenses outpace revenue in 2019 because of a number of factors, including weak inpatient admissions and increases in bad debt, according to a new report from Moody's Investors Service.

Incoming Senate Finance Committee leaders unveil bill to address Medicaid drug costs

December 6, 2018


Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), the incoming leaders of the Senate Finance Committee, released a draft bill that would provide HHS with the authority to penalize drugmakers participating in the Medicaid Drug Rebate Program for misclassifying their products.

The 10 signs of 'BS' in health care, according to Wharton economists

December 5, 2018


A special report by University of Pennsylvania health care economists suggests the health care industry suffers from an "acute" problem with "deceptive, misleading, unsubstantiated, and foolish statements"—otherwise known as health care "BS."

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.

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.

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