An HHS watchdog found hospitals wrongly billed Medicare for up to $25 million in cancer treatments, accounting for a nearly 25% bump in their bundled payments.
Progressive Democrats want to wrestle “Medicare for all” into their party's platform. But strategists, industry and the results of recent primaries say the country isn't ready for it yet.
Many health insurers are investing in privatized Medicare as well as the provider organizations that can improve the quality and lower the cost of seniors' care as the pool of eligible beneficiaries grows.
As scrutiny tightens on drug middlemen and the significance of their role in spiking drug costs within Medicare Part D, health insurers are hitting back with data that show the most expensive drugs offer the lowest rebates.
The CMS' move to allow Medicare Advantage plans to require patients to try low-cost generic drugs before more expensive therapies on Part B could lead to poor health outcomes, causing an increase in ED use and inpatient admissions, providers say.
The CMS is waiving an Obama-era guidance that prohibited Medicare Advantage plans from imposing prior authorization requirements on Part B drugs.
HHS revealed it has made progress reducing its Medicare appeals backlog and won't need to pursue the AHA's suggestions to expedite pending cases. But the agency conceded it won't be able to meet a federal judge's requirement to eliminate the backlog by the end of 2020.
Providers worry that the CMS, in its push to give patients greater access to both price and care information, may do more harm than good.
The CMS has not complied with a section of MACRA that requires it to impose prior authorization for chiropractic services, a government watchdog found. Chiropractors have one of the highest rates of improper payments in Medicare.
The CMS has finalized plans to give hospices nearly double the raise they received in 2018. The agency will also make it easier to check data on the troubled Hospice Compare website.
HHS will lower premiums for Medicare prescription drug plans next year, and the agency credited lower drug prices for the change.
Academic and rural hospitals will likely see a cut in Medicare funding if the CMS finalizes its proposal to reduce reimbursement for more-complex patients, according to Moody's Investors Service.