Posts Tagged ‘Centers for Medicare & Medicaid Services’
CMS proposes changes to PACE designed to modernize program
The Centers for Medicare and Medicaid (CMS) is proposing a number of changes to the regulations that control the Programs of All-Inclusive Care for the Elderly. PACE, as it is known, allows seniors, most of whom are eligible for Medicare and Medicaid, to live and receive care at home instead of in a skilled nursing…
Read MoreHow can investigators predict healthcare fraud?
Predictive modeling is a term that has been used a great deal lately in the context of healthcare fraud. In a nutshell, predictive modeling is the area of data mining concerned with forecasting probabilities and trends. Here in South Florida, many of us are familiar with its use through the forecasting of hurricanes. In the…
Read MoreTelemedicine gaining acceptance among payors
Although not entirely embraced by insurers, telemedicine is slowly becoming a more acceptable means of providing care. Even the federal government is starting to recognize telemedicine’s benefits. Earlier this month, The Centers for Medicare & Medicaid Services (CMS) proposed increasing telehealth coverage by adding new CPT codes for services beginning January 1, 2017 as part…
Read MoreCMS Proposes Changes to Meaningful Use Reporting Period
A reprieve could be on the way for the more than 200,000 healthcare providers who have been struggling to meet their electronic health reporting (EHR) requirements under the Meaningful Use Program. The Centers for Medicare and Medicaid (CMS) has announced a proposed rule that would  allow clinicians, hospitals and critical access hospitals to use a…
Read MoreFeds target healthcare fraud by looking for outliers
Last week, the U.S. Department of Justice announced the largest healthcare fraud takedown in its history. Approximately 300 defendants in 36 federal districts, including South Florida, were charged with engaging in fraudulent billings to the tune of more than $900 million. Charges included: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering…
Read MoreFlorida Home Health Agencies Targeted by CMS for Pre-claim Review
Florida is one of five states that the Centers for Medicare & Medicaid Services (CMS) is targeting for a three-year Medicare pre-claim review demonstration for home healthcare services. However, just how this program will work has raised questions in the home healthcare community. CMS says the steps it is taking are designed to “provide timely…
Read MoreCMS looks to formalize six-year lookback period for Medicare self-referral disclosures
The Centers for Medicare and Medicaid recently published a notice proposing revisions to its self-referral disclosure protocol (SRDP). The SRDP allows healthcare providers and suppliers to self-disclose actual or potential violations of the physician self-referral statute, or Stark Law. Under the proposal, healthcare providers who use the SRDP will have to provide the agency with…
Read MoreCMS unveils new Medicare payment proposal
On April 27, The Centers for Medicare and Medicaid (CMS) released, for public comment, proposed changes to how Medicare will pay providers. The proposed rule for the Medicare Access and CHIP Reauthorization Act (MACRA), enacted a year ago by Congress, eliminates the Sustainable Growth Rate (SGR) formula for setting reimbursement rates and simplifies many of…
Read MoreCMS announces new payment model for primary care physicians
The Centers for Medicare and Medicaid Services (CMS) last week announced a new risk-based primary care initiative designed to “transform and improve†how primary care physicians care for their patients by focusing on quality of care and outcomes over how many patients a physician can see in a given day. Dubbed the Comprehensive Primary Care…
Read MoreCMS proposes new payment model for Medicare Part B
The Centers for Medicare and Medicaid (CMS) is proposing a new rule that could result in a new Medicare Part B drug payment model. Published in the Federal Register, the agency is proposing a two-phase model that would test whether alternative drug payment designs would result in a reduction in Medicare costs, while at the…
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