Articles Tagged With: Medicare
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Dual-Eligible Medicare Advantage Plans Can Reduce Hospital Admissions
As U.S. healthcare providers shift to value-based care, they need to keep up with various governmental funding plans that could increase options for patients. For example, some states create opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans and Medicaid plans operated by the same insurer. Researchers suggest these plans can decrease inpatient admissions and nursing home admissions. -
Understanding Medical Necessity Improves Utilization Review Process, Reduces Denials
The case management team should be trained thoroughly on utilization review and medical necessity to avoid payer denials. The goal is to ensure patients receive medically necessary, high-quality care. -
Telemedicine Law Changes Confusing, but Waivers Protect During Pandemic
Legislation passed in December 2020 changed some telehealth requirements for mental health services. The change has prompted concern over false claims.
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Hospital-SNF Partnership Brings Better Care for Complex Patients
Coordinating post-acute services for patients has been an ongoing challenge during the COVID-19 pandemic. One solution is for hospitals to form partnerships with local skilled nursing facilities. These partnerships can help hospitals find adequate care for complex patients. Hospital case managers and other staff can help the skilled nursing facility with difficult problem-solving and care coordination.
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$12.5 Million False Claims Act Settlement Shows Government Loss Not Required
A False Claims Act lawsuit involving alleged kickbacks for placing drugs on formularies has been settled for $12.5 million. The case is instructive because it shows the False Claims Act can apply even when the government has not lost money from the alleged violations.
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Case Management Is Critical to Bundled Payment Programs
A healthcare organization’s Medicare Bundled Payments for Care Improvement Advanced (BCPI Advanced) program resulted in lower hospital readmission rates. The program reduced readmission rates from 30% to 19%.
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Surgeons, Anesthesiologists Raise Alarm Over Medicare Fee Cuts
The cuts could hurt several healthcare sectors at a time when the COVID-19 pandemic has taken a heavy financial toll.
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CMS Finalizes 2021 Physician Fee Schedule, Tinged with a Bit of Controversy
A budget neutrality provision leads industry groups to cry foul over Medicare cuts.
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New Research Suggests More Data on Readmissions Can Help
A recent study of Medicare data revealed facilities have many opportunities to improve readmissions — to either a medical or psychiatric hospital — after psychiatric hospitalization.
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Analysis: ASCs Saved Nearly $29 Billion in Medicare Costs 2011-2018
The authors estimated ambulatory surgery centers could reduce program costs by another $73.4 billion from 2019 to 2028.