Oncologists are looking to Congress for relief after having little luck in convincing the Biden administration to change the mandatory radiation oncology model that the American Society for Radiation Oncology says will hurt more than half of forced participants. CMS Innovation Center Director Liz Fowler recently disagreed with the radiologists’ take on the demo, and […]

The push to cut more than $1 trillion from Democrats’ social spending bill and possibly scrap a planned expansion of Medicare presents the biggest test to date of the Congressional Progressive Caucus’ clout. The 96 members, who account for nearly half of the House majority, showed their strength last month by delaying a bipartisan infrastructure […]

New vision, dental, and hearing benefits under Medicare must be included in Democrats’ social spending package if it’s going to win support from progressives, lawmakers said yesterday. “This to me is not negotiable,” Bernie Sanders (I-Vt.) told reporters when asked if cutting the added benefits is a red line for progressives. Progressive Caucus Chair Pramila Jayapal (D-Wash.), said her […]

Medicare managed-care plans say they’ll have to increase premiums and reduce benefit offerings if Democrats cut their program reimbursements to help pay for new dental, vision, and hearing benefits in traditional Medicare. Because these Medicare Advantage plans receive higher payments for beneficiaries with more ailments and higher expected medical costs, plan providers typically record all […]

A Biden administration push to make federal health programs more equitable for marginalized populations will likely result in fewer payment models in which providers assume direct financial risk, a top Centers for Medicare & Medicaid Services administrator said. Speaking at a conference of the National Association of Accountable Care Organizations on Thursday, Jonathan Blum, principal […]

A government watchdog agency is calling for greater oversight of 20 private Medicare Advantage plans that received a disproportionate share of $9.2 billion in enhanced payments in 2016 that were based on potentially suspect patient diagnoses. The Health and Human Services Office of Inspector General’s report released Wednesday said the enhanced “risk-adjusted” payments were generated through both […]

Eight long-term care providers will recover more Medicare money to satisfy bad debts because the federal government wrongfully reduced payments for years they weren’t enrolled in state Medicaid programs, a federal court said. The Centers for Medicare and Medicaid Services, a part of the U.S. Health and Human Services Department, must reevaluate nearly $2 million […]

A North Carolina hospital unhappy with the relief it received after asking a Medicare contractor to reopen a reimbursement decision is barred from seeking formal agency review because it voluntarily withdrew its first appeal, a federal court said Monday. A Provider Reimbursement Review Board rule forbidding a second formal appeal when the first has been […]

House Energy & Commerce Chair Frank Pallone recently pledged to work with lawmakers from both parties moving forward to avert physician pay cuts, but the New Jersey Democrat said now’s not the time to act given CMS just received comments on its proposed 2022 fee schedule. Lawmakers from both parties want to eventually stop the […]