Latest Headlines

Latest Headlines

Sixteen hospitals settle allegations of unnecessary outpatient psychotherapy for $15.7M

Sixteen hospitals across seven states have agreed to a $15.7 million settlement with the federal government to resolve claims that the providers improperly billed Medicare for Intensive Outpatient Psychotherapy, according to a Department of Justice statement.

Second-year Pioneer ACO results 'encouraging'

Accountable care organizations aligned with Medicare's Pioneer ACO program saw smaller increases in Medicare spending compared to general Medicare fee-for-service beneficiaries in the Pioneer program's second year, according to a study published in the  Journal of the American Medical Association.

MIPS or APM: Which is better for your practice?

Now that the Sustainable Growth Rate is no more, practices must choose one of two paths for reimbursement going forward. 

Bundled payment project saved $1M in first year

The jury still remains out on many bundled payment programs, but one such effort by Baptist Health in San Antonio and the Centers for Medicare & Medicaid Services saved more than $1 million during its first year of operation, according to a CMS report on the project.    

Medicare faces huge backlog of claims appeals

Medicare officials must work through the program's huge backlog of appeals claims, which is currently taking more than 500 days, senators said during a hearing on Medicare audits and appeals Tuesday.

Recent improper billing activity tops $120 million in Georgia

More than $120 million in improper billing activity has taken place in Georgia over the past week. On Monday, a hospital settled allegations from federal prosecutors that it violated the False Claims Act by cutting a check for $20 million. Meanwhile, Centers for Medicare & Medicaid Services officials want the state's Medicaid program to return $100 million in overpayments to nursing homes.

President Obama: Let Medicare officials negotiate drug prices

In his recent 2016 budget request to Congress,  President Barack Obama expressed growing concerns over the high costs of Medicare prescription drugs. His solution to the problem: Let Medicare officials negotiate prices with drug manufacturers. Currently, federal law prohibits such negotiations.

As NFL players take hits, insurers collect cash

Last week, the National Football League approved a settlement that would issue payments to injured players after the league failed to properly investigate and respond to concussion-causing hits. However, a big slice of the payments will instead go to the players' health insurers.

Puerto Rico struggles with low levels of fed provider reimbursement

The federal government pays providers in Puerto Rico a fraction of what their counterparts in the United States receive--about 70 percent lower for Medicaid providers, creating a fiscal crisis.

What will the end of the SGR bring, besides more acronyms?

What do we know so far about Medicare's replacement for the Sustainable Growth Rate formula, the Medicare Access and CHIP Reauthorization Act of 2015?