HHS Reports That Only 14 Percent of Patient Harm Events Experienced by Medicare Beneficiaries Are CapturedKip Piper -
A study conducted by the HHS Office of Inspector General, Hospital Incident Reporting Systems Do Not Capture Most Patient Harm, analyzed the ways in which hospitals use incident reporting systems and incident reports to determine how accurately this reflected actual patient harm occurring within hospitals. The study also aimed...
Medicare Secondary Payer: Options for Improving Medicare Payment Recoveries from Individual, Non-Group Health PlansKip Piper -
The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware of all such situations in the past, 2007 legislation introduced mandatory non-group health...
Lack of Price Transparency Could Limit Hospitals’ Ability to Secure Favorable Pricing for Implantable Medical DevicesKip Piper -
Policymakers expressed concern about the lack in price transparency for implantable medical devices (IMD), with confidentiality clauses in purchasing agreements frequently restricting the release of third-party prices. Because this lack of transparency could drive up hospital cost and Medicare spending, GAO examined trends in IMD Medicare spending and utilization,...
Medicare: American Enterprise Institute for Public Policy Research Finds Competitive Bidding Could Solve Fiscal CrisisKip Piper -
As a natural outcome of program incentives, physicians and other health care providers are motivated to deliver more services as a means to increase Medicare fee-for-service (FFS) payments. Chronic overtreatment, and the resulting overpayment, has led Medicare into its current financial crisis. Medicare’s private insurance plans, Medicare Advantage (MA) plans,...
Medicare Advantage and Risk Adjustment: GAO Advises CMS to Improve Risk Score Adjustments for Diagnostic CodingKip Piper -
Over time, the Centers for Medicare and Medicaid Services (CMS) has revised the risk adjustment methodology for Medicare Advantage plan payments. The risk adjustment process calculates a risk score for each Medicare Advantage (MA) plan enrollee, consistent with specific demographic factors and health status. An MA plan's overall risk score...
Medicare Payment Reform and Quality Improvement: MedPAC Recommendations to Congress on Medical Imaging and Poor Quality ProvidersKip Piper -
The Medicare Payment Advisory Commission (MedPAC) has made 10 new recommendations to Congress regarding Medicare payment accuracy and financial incentives for medical imaging and other diagnostic testing, and quality improvement, targeting the worse performing Medicare providers for intensive technical assistance. MedPAC – an advisory agency to Congress with a 17-member...
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