On April 24, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for fiscal year 2019 for the Inpatient Prospective Payment System (IPPS). In the rule, CMS included...
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Council for Medicare Integrity urges CMS to implement prepayment claim reviews in the fee-for-service program
On April 24, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for fiscal year 2019 for the Inpatient Prospective Payment System (IPPS). In the rule, CMS included...
Does the Individual Mandate still exist?
The Affordable Care Act's individual mandate—which required consumers to enroll in health insurance or pay a penalty fee—has been at the forefront of health care reform debate for years. And while a...
Update on the American Hospital Association law suit against the US Department of Health and Human Services concerning Medicare Appeals backlog
Recently, a federal judge in the District of Columbia asked the American Hospital Association (AHA) for ideas on how the U.S. Department of Health and Human Services (HHS) can deal with the...
Does the Individual Mandate still exist?
The Affordable Care Act's individual mandate—which required consumers to enroll in health insurance or pay a penalty fee—has been at the forefront of health care reform debate for years. And while a...
Update on the American Hospital Association law suit against the US Department of Health and Human Services concerning Medicare Appeals backlog
Recently, a federal judge in the District of Columbia asked the American Hospital Association (AHA) for ideas on how the U.S. Department of Health and Human Services (HHS) can deal with the...
When an Emergency is not an Emergency – Changes in ED coverage policies
For some patients, a visit to the emergency department may now come with unexpected costs, as health plans—including Medicaid—begin to roll out new policies that aim to discourage "preventable"...
New CMS Issues and Risk Based ADR Limits
In this month's article we focus on the Medicare Recovery Audit (RA) Contractor Program, providing you an update on recently approved issues for RAs to review and an update to the institutional...
Current “State” of Medicaid Waivers
Over the past year, Section 1115 Medicaid demonstration waivers have been growing in popularity as state policy makers have looked for ways to implement innovative Medicaid programs to enhance the...
New Medicare ID Cards in the next 60 days
The Centers for Medicare & Medicaid Services (CMS) is required to remove Social Security Numbers (SSN) from all Medicare cards by April 2019, replacing the current SSN-based Health Insurance...