Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

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...
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...
The Government Accountability Office (GAO) recommended in a recent report that the Internal Revenue Service (IRS) step up its enforcement of tax collections for Medicaid providers, finding that providers in three selected states owed nearly $800 million in unpaid taxes. In particular, the GAO suggested the IRS collect taxes...
State Medicaid directors need greater flexibility and faster federal approval to maintain or establish new managed long-term supports and services (MLTSS) programs in Medicaid. A growing number of states are implementing such programs, from 8 states in 2004 to 16 states in 2012. “A strong and effective federal-state partnership with clearly aligned...
Hospitals ought to invest in processes that keep discharged patients from returning, and should do so for two main reasons, a new report argues: (1) readmissions are costly and are increasingly a concern for Medicare, Medicaid, and private payers, and (2) steps to reduce readmissions will prepare hospitals for...
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...
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 million went to HHS’s Agency for Healthcare Research and Quality (AHRQ) to support...
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...
The AHRQ released its background report, National Advisory Council Subcommittee: Identifying Health Care Quality Measures for Medicaid-Eligible Adults. Required by the Affordable Care Act, this report identified a recommended core set of quality measures for Medicaid-eligible adults. Also aimed at providing states with insight into health care quality for...
Federal and state Medicaid spending currently exceeds $460 billion and, with this, accountability is necessary on all levels. To ensure Medicaid program integrity: Consistent incentives must be offered for better health outcomes. Services must be used appropriately. The program must be monitored on an ongoing basis. Programs must be managed efficiently. In an excellent new...

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