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Medicare

Latest Headlines

Latest Headlines

Bundled payments may be more cost effective than ACOs

​A new report on the Medicare program's attempt to remake the nation's healthcare finance system praised accountable care organizations but also pushed for the continued use of bundled payments to facilitate lower-cost, higher-quality care.

GAO: Not enough transparency in how CMS values clinical work

The process for determining how much work a physician puts into completing a particular clinical task is often inflated and inaccurate, creating problems when Medicare and other federal agencies attempt to place an appropriate value on the task, according to a new report by the Government Accountability Office.

Do Medicare's financial penalties to improve care actually work?

The Medicare program has financially penalized hospitals for years for not preventing avoidable injuries to patients while they're hospitalized, but it is hard to determine whether that program has had a concrete impact.

Hospitals have improved productivity dramatically in recent years

Is it truly possible for hospitals to become more productive, providing patients with better care for less money? Apparently yes, according to recent research that examined productivity growth in U.S. hospitals that treated Medicare patients who had a heart attack, heart failure and pneumonia during 2002-2011.

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.