Medicare & Medicaid
The GUIDE model is to support people with Medicare living with dementia and their unpaid caregivers.
For both, CMS is modifying the COVID-19 Vaccination Coverage Among Healthcare Personnel measure that will affect the 2025 payments.
More than 75% of the 4,654 hospitals in the Care Compare Dataset for 2023 received 2, 3 or 4 stars.
CMS last week cracked down on noncompliance by pausing the redetermination process in several states.
The managed care organizations in the review denied one out of every eight requests for prior authorization in 2019.
The scheme involved genetic testing and durable medical equipment that patients did not need, which the defendants procured with kickbacks.
CMS is proposing to update OPPS payment rates for CY 2024 for hospitals that meet applicable quality reporting requirements by 2.8%.
CMS is also proposing increases in payment for many visit services, such as primary care, and changes impacting cancer treatment.
For health plans, authors expect the study can provide a better understanding of the core customer segments of MA.
The allegations involved HCA billing Medicaid improperly for three separate behavioral health services available to children who qualify.