Medicare and Medicaid spending will exceed $1 trillion in FY 2013. Together, the two programs now serve about 113 million Americans - over a third of the population. Policymakers in Washington and the states face a daunting challenge to containing costs in Medicare and Medicaid – both health programs are...
Prescription drugs often play an important role in keeping people healthy, especially for people with chronic conditions. Medicare beneficiaries with diabetes or asthma, for example, might take regular medicines to prevent emergencies that would put them in the hospital. Hospital stays, doctor’s appointments, and other medical services covered under...
Medicare Reimbursement Explained: MedPAC Briefings on Medicare Payment Methods for Providers, Medicare Advantage, and Drug PlansKip Piper -
Medicare program payment methods are highly complex and change constantly. The Affordable Care Act (ACA) makes further, very significant changes to how Medicare pays hospitals, physicians, post-acute providers, and Medicare Advantage health plans. In a series of excellent briefs, the Medicare Payment Advisory Commission (MedPAC) explains the basics of Medicare reimbusement, including...
Kip Piper -
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion annually. Together with state Medicaid agencies and state attorneys general, several federal offices, such...
Kip Piper -
Medicare Advantage plans provide many benefits to Medicare beneficiaries, including lower costs, added services, higher quality than traditional fee-for-service (FFS), and less paperwork. However, the way Medicare paid Medicare Advantage health plans led to a situation where Medicare was paying health plans more than the average cost of Medicare FFS...
Medicare’s new value-based payment method for reimbursing physicians will begin in 2015 to affect physician groups with at least 25 eligible professionals. Groups will have the option to participate in a tiered payment system, which would adjust Medicare Part B fee schedule payment rates by an as-yet undetermined amount or...
Medicare Value-Based Physician Payment Modifier: Recommendations from Physicians, Health Plans, and Policy ExpertsKip Piper -
Medicare is slowly but steadily moving toward value-based methods of reimbursing physicians, hospitals, and other health care providers differentially based on quality and cost of care. The evolving payment methods add performance or value-based modifiers to traditional Medicare fee-for-service reimbursement. For physicians, new value-based payment modifiers will adjust each provider's payment rates under the Medicare Part B fee...
Medicare Reimbursement: Medicare Payment Methods for Providers, Medicare Advantage Plans, and Medicare Part D Drug PlansKip Piper -
Medicare reimbursement methods are highly complex and constantly changing. Here are a series of concise briefings on Medicare payment policy for healthcare providers, Medicare Advantage plans, and Medicare Part D drug plans. These primers on Medicare payment basics are courtesy of the outstanding staff at the Medicare Payment Advisory Commission...
Kip Piper -
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent among individuals in similar demographics and with a comparable health status. Following policymaker concerns...
Medicare Fee-for-Service Benefits: Impact of Medicare Cost Sharing Changes on Beneficiaries and BudgetKip Piper -
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...
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