Archive for April 2016
States’ failure to implement NCCI edits cost Medicaid program billions annually
Improper payments to healthcare providers cost the Medicaid program approximately $17.5 billion in fiscal year 2014, according to a new report from the HHS Office of the Inspector General. The reason: States’ failure to fully implement or properly use Medicaid National Correct Coding Initiative (NCCI) edits. The purpose of the NCCI edits is to prevent…
Read MoreCMS announces new payment model for primary care physicians
The Centers for Medicare and Medicaid Services (CMS) last week announced a new risk-based primary care initiative designed to “transform and improve†how primary care physicians care for their patients by focusing on quality of care and outcomes over how many patients a physician can see in a given day. Dubbed the Comprehensive Primary Care…
Read MoreHealthcare Fraud and Abuse Crackdown Not Slowing as Evidenced by Recent Cases
The federal government has been busy since the beginning of the year announcing arrests, convictions and settlements relating to healthcare fraud and abuse. The activities relate to violations of the Stark Law, anti-kickback law and federal False Claims Act, and there appears to be no end in sight. Whether it’s home health, transportation, durable medical…
Read MoreCMS proposes new payment model for Medicare Part B
The Centers for Medicare and Medicaid (CMS) is proposing a new rule that could result in a new Medicare Part B drug payment model. Published in the Federal Register, the agency is proposing a two-phase model that would test whether alternative drug payment designs would result in a reduction in Medicare costs, while at the…
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