Insurance

In what is likely to be a relief to dialysis providers, the CMS decided to phase in the controversial payment cut to dialysis providers over a three- to four-year period.

Electronic health records are changing the way your family doctor does business, with most now able to view lab results or send a prescription online, a change that advocates say will improve efficiency and lead to fewer medical errors.

New case management model achieves success in reducing readmissions and is easily duplicated across the Baptist Health System, Inc.

The administration was warned last spring that its website didn't meet key requirements for a successful rollout, including relying too heavily on outside contractors, according to a copy of a Red Team report.

More than 200 participants gathered in Baltimore for "Patient-Centered Oncology: Real-World Perspectives," which covered genetic testing, how to engage patients in decision-making, and how the "culture of medicine" continues to drive up costs despite calls to abandon the fee-for-service payment model.

Medicare payment reforms require valid measures of high-quality healthcare. Different types of administrative wait time measures predicted glycated hemoglobin levels for new and returning patients.

Finding a health plan on the Medicare website could be troublesome for some seniors.

More hospitals are receiving penalties than bonuses in the second year of Medicare's quality incentive program, and the average penalty is steeper than it was last year, government records show.

Researchers who want to study population health using the vast stores of Medicare and Medicaid data will no longer have to order it and wait for the federal government to ship them encrypted data files.

CMS Administrator Touted HealthCare.gov on Eve of Troubled Rollout

The American Journal of Managed Care recently sat with Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), as she discussed CMS's role in the new, evolving healthcare landscape. This special AJMCtv interview highlights just some of the initiatives CMS has implemented, as well as some of the challenges that remain for the organization.

For all the current focus on Obamacare lurching into its infancy, 50-year-old Medicare is also undergoing profound and disruptive change as Congress struggles with soaring medical bills and a growing senior population.

The Senate Finance Committee and House Ways and Means Committee jointly released their draft legislation to reform physician payment under Medicare on October 30.

The premiums for Medicare Part B will remain flat in 2014 and seniors have saved $8.3 billion on Part D prescriptions since the Affordable Care Act was enacted in 2010, the Department of Health and Human Services announced Monday.

Many physicians around the country are getting notices from Advantage plans that they are being cut from private insurers' networks. In addition, some insurers have announced they are reducing their Advantage plan offerings in some states, trimming extra benefits and increasing patient cost sharing.

Raising the eligibility age for enrolling in Medicare won't produce nearly the cost savings that had been assumed previously, said a new report issued Thursday.

This study identified inefficiencies in drug and medical service utilization related to pain management among Medicare members with osteoarthritis and chronic low back pain.

Convention wisdom has long held that hospitals make up for reimbursement shortfalls in government insurance and uncompensated care by shifting those costs to the privately insured.

Katherine Baicker, PhD, professor of health economics, Department of Health Policy and Management, Harvard School of Public Health, says that Medicare Advantage Plans still hold promise to deliver high-value, better-tailored care to beneficiaries.

Connecticut seniors on Medicare are more likely to take sedatives for insomnia and medications for depression than their counterparts across the country, according to a new report by Dartmouth researchers.

Seniors need to examine insurance plans carefully to avoid devastating financial surprises. It's not easy, though, as insurance becomes increasingly complex with sometimes widely disparate rules for various scenarios.

The debt ceiling has been raised, and that means that the government will be looking for ways to control long-term budget expenditures, including those for programs like Medicare.

As the dust settled following yesterday's last-minute budget deal to avert a federal government's default, a frightening fact emerged for the nation's doctors.

Dual eligibles-the class of Americans that qualify for both Medicaid and Medicare coverage-are mostly older adults with low incomes and tend to be the sickest beneficiaries covered by either Medicaid or Medicare.

Almost all pharmacy and therapeutic committees have a unique process for evidence-based formulary decision making, said Steven Pearson, MD, founder & president, Institute for Clinical and Economic Review.

Edmund J. Pezalla, MD, MPH, national medical director, Aetna Pharmacy Management, suggest that the healthcare industry will continue to move in the direction of providing patients incentives to make use of health risk assessment tools and screenings.

Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, says the federal Medicare program not only has a spending problem, but a delivery system problem that the fee-for-service model has not solved.

Hospitals spend less on operations-largely by squeezing labor costs-to make up for lost revenue when Medicare cuts hospital prices, according to a study.