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 […]

More than 70 bipartisan House members have joined a slew of medical organizations in calling for the Biden administration to nix portions of a proposed rule that would cut Medicare payment rates for some specialists by up to 20% next year. The lawmakers say the cuts in the proposed 2022 Medicare Physician Fee Schedule would […]

The Biden administration is calling for Congress to pass a set of proposals already backed by Democrats to lower prescription drug prices, including one to let the government negotiate prices with drugmakers. The proposals unveiled Thursday are part of a long-awaited report from the HHS to the White House that offers a wide-ranging series of recommendations on […]

The Covid-19 pandemic is the nudge the Medicare and Medicaid agency needed to rethink what quality measures it asks providers to report, health policy experts said. The industry is questioning the utility of having so many quality measures at a moment when doctors and resources are stretched thin. Providers said the measures can be easy […]

The Medicare Payment Advisory Commission could recommend that Congress provide immediate one-time or temporary payment rate increases to providers that suffered financially during the pandemic. In the panel’s first meeting of its 2021-2022 cycle on Thursday, commission member Paul Ginsburg called for the recommendation and said it should be made along with the commission’s annual […]