New Exclusion Rules to Take Effect Next Month

Earlier this month, the Health and Human Services Office of the Inspector General (HHS-OIG) finalized its long-awaited rules on civil monetary penalties that could make it easier for providers to be excluded from participating in the Medicare and Medicaid programs. The final rule, which was published in the Federal Register on January 12, was first […]

States’ failure to implement NCCI edits cost Medicaid program billions annually

Improper payments to healthcare providers cost the Medicaid program approximately $17.5 billion in fiscal year 2014, according to a new report from the HHS Office of the Inspector General. The reason: States’ failure to fully implement or properly use Medicaid National Correct Coding Initiative (NCCI) edits. The purpose of the NCCI edits is to prevent […]

CMS: Medicare ACOs find success in savings, improved quality

The recent news that Medicare Accountable Care Organizations (ACOs) generated net savings of $411 million in 2014 and improved in most quality measures is being hailed as a success by the Centers for Medicare and Medicaid (CMS). These ACOs, which were established under the Affordable Care Act, are the center of the nation’s healthcare reform […]

CMS releases final rule for Medicare Shared Savings Program ACOs

The Centers for Medicare & Medicaid (CMS) earlier this month released its much- anticipated Final Rule updating the Medicare Shared Savings Program. The whole concept behind the program, created by the Affordable Care Act (ACA), is to encourage participation among providers through the use of accountable care organizations (ACOs). ACOs are groups of providers that […]

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