Insurance

CMS audits have found that some health insurance plans are struggling with the same issues year after year, which is concerning, said Sarah J. Lorance, vice president of Medicare compliance at Anthem.

San Diego County is doing much better than the national average at reducing readmissions to hospitals, yet nearly all their eligible hospitals are being penalized by Medicare's hospital readmissions penalty program.

Researchers at Stanford University found that when CMS stopped paying for 2 preventable, hospital-acquired conditions in particular, the incidence of the conditions dropped 35% in the Medicare population.

Anthem, Inc, increased its managed care footprint in the state of Florida. On Monday, the company has entered into an agreement to acquire Simply Healthcare Holdings, Inc.

CMS' Sean Cavanaugh announces in a blog post that 89 newcomers will participate in 2015. But ACOs remain a work in progress, with rule changes on the way and some discussion about whether these entities are assuming enough risk or dampening competition in certain markets.

Accountable care organizations (ACOs) are still a new creature in the world of managed care, and not all are alike. As the authors of a new comparative analysis in The American Journal of Managed Care outline, Medicare contracts dominate the ACO landscape, with only half of these entities having a contract with a private payer.

More than 700 hospitals will be penalized in fiscal year 2015 as a result of poor scores in CMS' Hospital-Acquired Condition (HAC) Reduction Program.

In the next several weeks more than 257,000 physicians and other healthcare providers will receive notification that 1% of their pay next year will be penalized for failing to meet meaningful use, CMS announced Wednesday.

States designing and testing healthcare payment and service delivery models to improve quality of care and lower costs will be receiving more than $665 million in funding from the government, according to HHS Secretary Sylvia M. Burwell.

Substituting telehealth services for in-person visits can generate savings of roughly $126 per commercial telehealth visit, according to a new actuarial study from the Alliance for Connected Care.

The authors find 51% of accountable care organizations have private payer contracts, which are more likely than public contracts to include downside risk and upfront payments.

The rule being published tomorrow not only grants same-sex spouses the right to act as medical decision-makers, but it also requires Medicare and Medicaid providers to inform patients of these rights.

The Sunshine State seeks to hold down costs with managed care for its Medicaid population and seniors, but it's meeting resistance.

Rules issued today will help CMS keep fraudulent providers and suppliers away from Medicare, following a series of crackdowns in "hot spots" around the country.

The 3-year pilot is expected to reel-in significant cost savings for Medicare, which has seen a lot of fraudulent charges with services and equipment.

The call for value-based care is propelled by the shortage of family physicians and the disparity connection between the time it takes to care for the sickest patients and what Medicare and Medicaid pay. A study in this month's issue of The American Journal of Managed Care tracks just how bad things are, by looking at a normal day in a family practice.

Authors in the New England Journal of Medicine discuss the prospects and pitfalls of implementing a new CMS fee for physicians who coordinate care for Medicare patients with multiple chronic conditions.

Amid last week's news that CMS had miscalculated the number of enrollees under the Affordable Care Act was a quieter announcement that the agency had appointed a chief data office to improve transparency, among other tasks.

Greater geographic variation was found among private than public payers in the inpatient price per discharge for most hospital services.

In an effort to foster greater transparency of healthcare costs, the government and private sector entities are offering tools that provide cost and quality information to consumers. But just how effective are these tools?

Medicare Advantage enrollment decreases with lower rebates for supplemental benefits. Upcoming ACA reforms are predicted to reduce MA enrollment where traditional Medicare costs are low.

In a paper published in the Journal of Clinical Oncology, medical oncologists have delineated their recommendations to improve cancer care and provide better access to quality care for those patients with financial issues and on Medicaid.