CMS unveils proposed rules for Medicaid managed care plans

A close up of several folders in different colors.

On May 26, The Centers for Medicare & Medicaid Services (CMS) released its long-awaited proposed rule, updating its Medicaid managed care organization regulations. The proposal is designed to “better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing…

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GAO: Government misspent billions on Medicare/Medicaid

A bunch of money that is in the shape of a bird.

Last year, Medicare financed health services for approximately 54 million elderly and disabled beneficiaries at a total cost of $603 billion. Of that, approximately $60 billion went toward improper payments, according to a report issued last week by the Government Accountability Office (GAO) Most of that misspent money, about $45.8 billion, went toward the Medicare…

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CMS says ICD-10 testing successful: Are you prepared?

A close up of a stethoscope with the dollar sign on it

The Centers for Medicare and Medicaid Services is reporting that it successfully completed the first week of end-to-end testing of the soon-to-be-implemented ICD-10 coding. The testing, which took place between Jan. 26 and Feb. 3, included 661 participants with about 1,400 National Provider Identifiers registered. They were split equally between direct submitters and clearing houses/billing…

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GAO: CMS ready for ICD-10, but are you?

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There is good news for healthcare providers coming out of the Government Accountability Office: The Centers for Medicare and Medicaid Services is prepared for the switch to ICD-10 on Oct. 1, according to a newly released report. The 41-page report notes that CMS has undertaken “a number of efforts†to prepare for transition to the…

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CMS cracking down on fraudsters

A pile of money with the words medicare fraud.

Federal agencies are stepping up their efforts to go after providers who engage in healthcare fraud and abuse. On Dec. 3, the Centers for Medicare & Medicaid services issued new rules designed to crack down on what the agency refers to as “bad actors,†as part of an effort to increase oversight of Medicare providers,…

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