Medicare & Medicaid

The AMA is advocating for appropriate risk adjustment of performance results based on clinical and social determinants of health to avoid penalizing physicians.

Regulatory reform is estimated to save the healthcare system an estimated 40 million hours and $5.7 billion from 2019 through 2021.

Programs of All-Inclusive Care for the Elderly organizations are also being allowed new flexibilities for care.

An additional 355,184 people would have been screened for colorectal cancer if non-expansion states had seen the same increases in screenings.

The ratio of private insurance to Medicare payments is even higher than the 209 percent average at some hospitals.

The spread amount must be included in the calculation of medical loss ratios that managed Medicaid and CHIP plans use to set premium rates, CMS says.

Patient Advocate Foundation Vice President Rebekah Angove discusses the difference between patient engagement and patient experience and how patients and providers can more effectively navigate the complexity of healthcare costs.

Study recommends employers pressure health plans and hospitals to shift to contracts based on a multiple of Medicare or other prospective case rates.

Fraudulent medical practice is estimated to cost the federal government between $90 to $300 billion dollars annually.

Medicaid paid Acadia's facilities a much higher amount for blood and urine tests than its lab had charged for the analysis.