Medicare & Medicaid
The law was a response to complaints from Medicare patients who were surprised to learn that although they had spent a few days in the hospital, they were there for observation and were not admitted. Observation patients are considered too sick to go home yet not sick enough to be admitted. They may pay higher charges than admitted patients and do not qualify for Medicare's nursing home coverage.
The Centers for Medicare and Medicaid Services on Monday proposed a new rule intended to reduce overuse of antibiotics, implement comprehensive requirements for infection prevention and prohibit discrimination.
CMS is awarding $10 million over the next three years to organizations that will help clinicians transition to the new quality payment system outlined under MACRA.
Fewer than one-quarter of hospitals in the United States are on track to hit the Obama administration's 2018 goal of providing at least half of their patient care through value-based arrangements -- structures that tie reimbursement from Medicare to the quality of care patients receive.
Despite interventions by Medicare officials, the number of appeals from health care providers and patients challenging denied claims continues to spiral, increasing the backlog of cases and delaying many decisions well beyond the timeframes set by law, according to a government study released Thursday.
The Centers for Medicare and Medicaid Services has temporarily suspended its review of short stay patient claims to give reviewers time to improve the standardization around the two midnight rule, CMS said in a June 6 update.
In a new rule issued Wednesday, CMS is shutting down loopholes that allow short-term plans to operate outside the policies governing the ACA's single risk pool.
While reforms tied to the Affordable Care Act have most healthcare providers focusing on quality and efficiency, financial experts say the dramatic change in business model is driving improvement in credit ratings.
CMS has seen no adverse health outcomes due to the new fee schedule.
Eligibility for enrollment is being determined using pre-existing data from the Supplemental Nutrition Assistance Program.