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

Special Needs Plans are a type of Medicare Advantage plan that is allowed to selectively market and enroll Medicare beneficiaries with special needs.  Special Needs Plans (SNPs) offer the opportunity to improve care for Medicare beneficiaries with special needs, primarily through improved coordination and continuity of care.  SNPs must also...
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...
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...
Because preventative care can reduce expenditures and improve health outcomes, the GAO conducted a study examining actual preventative service use in relation to the U.S. Preventative Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) by Medicare fee-for-service (FFS) beneficiaries. This study also examined whether or not the...
The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities.  A dozen states are now looking...
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,...
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...
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...
Medicare Advantage plans and Medicare Part D prescription drug plans face an extraordinary array of changes as a result of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). These include: New payment benchmarks for Medicare Advantage (MA) plans, phased in 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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