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...
Kip Piper -
Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or other government health programs. To help prevent fraud, waste, and abuse in Medicare and...
Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, by Marc Bard and Mike NugentKip Piper -
Are you ready to be an Accountable Care Organization (ACO)? Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to form an Accountable Care Organization. Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation is...
Compliance Challenges of Health Reform: Questions Compliance Professionals Should Ask as They Prepare for Health Care ReformKip Piper -
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially for health plans, physicians, hospitals and health systems, and drug and device manufacturers. In...
Medicaid Fraud and Abuse: Investigations, Prosecutions, Spending, and Staffing by State Medicaid Fraud Control Units in 2010Kip Piper -
Nearly every State has a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute cases of Medicaid fraud and patient abuse and neglect. MFCUs are a key part of an array of federal and state agencies combating healthcare fraud and abuse, including State Medicaid agencies, the HHS Office of Inspector General (OIG),...
Medicare and Medicaid Fraud: Voluntary Self-Disclosure of Potential Fraud by Hospitals, Physicians, and Other ProvidersKip Piper -
Medicare and Medicaid program integrity efforts – coupled with complex coding and claiming procedures, ever-increasing program requirements, new payment methods, and the growing market share of taxpayer-funded programs – present significant compliance challenges for health plans, hospitals, physicians, pharmaceutical and biotechnology firms, medical device makers, and other providers and suppliers. The...
The federal Medicare program has an array of complex payment policies for health care providers, health plans, and prescription drug plans. Fortunately, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) offer a series of crisp primers on Medicare reimbursement policy. MedPAC updates these annually to reflect changes...
Medicare Data Book for 2010: MedPAC Data on Medicare Spending, Enrollment, Providers, Health Plans, Drug Plans, and MoreKip Piper -
MedPAC released its Medicare Data Book for 2010, with a wide range of useful information on Medicare spending, utilization, beneficiaries, providers, health plans, drug plans, access, and quality. The format is reader-friendly charts and tables with bulleted summaries. Specifically, the latest MedPAC Data Book includes information on: Medicare spending, including Medicare...
The federal health reform legislation - Patient Protection and Affordable Care Act (PPACA) - includes an ambitious list of changes to long-term care (LTC) services for seniors and the disabled. Most include a massive infusion of federal funding to help state Medicaid programs provide more LTC through home and...
The Medicare Payment Advisory Commission (MedPAC) has released its Medicare payment recommendations to Congress for 2011. In addition to specific recommendations for payment updates for fee-for-service providers and Medicare Advantage plans, MedPAC's report includes interesting information and analysis on spending trends, consequences of rapid spending on Medicare and the...
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