Insurance

The authors demonstrate the utility of distributed data models for reporting of local trends and variation in utilization, pricing, and spending for commercially insured beneficiaries.

This study investigated the impact of an enhanced preventive care delivery system on healthcare expenditure and utilization trends among Medicare Advantage beneficiaries.

The two studies, published in the August issue of JAMA Internal Medicine, examine the pros and cons of the current cancer screening methodologies.

The study, published in the journal Health Service Research, found that the timing of the financial incentives offered by the program was not associated with improved quality of care.

A new Kaiser Family Foundation report analyzes key trends that have shaped the Medicare Part D marketplace since the program launched nine years ago, providing a detailed assessment of changes in plan availability, enrollment, premiums and cost sharing in both private stand-alone drug plans, and Medicare Advantage drug plans.

The final decision on the proposal will be made only after a 30-day comment period.

HHS said that many Medicare Advantage plans wrongly inflated patient risk scores, costing the government billions. Although no insurers were specifically named, HHS researchers said it was evident that the practice of overbilling was occurring industry wide.

Next year, U.S. healthcare providers will be subject to Medicare penalties if they do not meet up to 26 measures for value-based purchasing.

The CMS has removed the provider review version of a new database that details financial relationships between healthcare providers and drug and medical-device manufacturers.

High rate of hospice survivors, especially in Alabama and Mississippi, have raised doubts about improper practices.

The federal government this month quietly stopped publicly reporting when hospitals leave foreign objects in patients' bodies or make a host of other life-threatening mistakes.

The pharmacy benefit manager has decided to choose formulations that provide equivalent benefit at lower cost.

According to a recent survey, hospitalists said that the 2-midnight rule is negatively impacting patient care as well as patient finances.

CMS has announced that it will nearly double the number of candidates in its bundled payment program. As part of the Affordable Care Act, the program aims to reduce care costs and improve patients' quality of care by offering providers with an alternative to the traditional fee-for-service reimbursement model.

A study just published in The American Journal of Managed Care examined how benefit design differences affected seniors who received prescription coverage through Medicare Advantage compared with a stand-alone Medicare drug plan. The review showed that integrating drug coverage with medical care resulted in fewer barriers to name-brand drugs, with lower copayments.

Active implementation of cost-saving measures successfully cut down expenditure at the Norris Comprehensive Cancer Center.

Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option.

To better align the care of beneficiaries insured under both the Medicaid and Medicare programs, CMS invited states to participate in a 3-year demonstration project. However, it seems that many beneficiaries have opted out of these care coordination programs that are offered across the country.

Dr Benner presented a program that helps providers improve medication adherence among their patients.

Medicare-Advantage Prescription drug plans (MA-PDs) and standalone PDPs appear to respond to different incentives for plan design.

Changes to a hospice drug rule will reduce the types of medications that require prior authorization. Previous rules prohibited Medicare hospice patients from filling their Part D medications until they had confirmed that hospice providers did not cover them first.

Eighty-nine members of Congress have asked the Centers for Medicare & Medicaid Services to give pathologists a break and extend the hardship exemption they currently enjoy for all of Stage 3 of the Meaningful Use program.

Health insurers are increasingly turning to telehealth, a transition that will change the way that providers assess and treat patients.

Fewer patients linger for days in hospitals without being admitted because of a new federal rule, but hospital and consumer groups are suing the government because they say the policy compromises Medicare patients' care, and patients are often stuck with costly, unexpected bills.

Wellness and behavioral health visits are among a few telehealth coverage expansions the CMS wants to add to the list of Medicare-reimbursable telehealth activities under a proposal released Thursday.

Despite increased spending, the breast cancer detection rate and stage did not change, according to a new JNCI study.

The number of healthcare organizations participating in CMS's bundled payment program is expected to increase in upcoming weeks.

Most 30-day readmissions are experienced by patients who have multiple hospital stays. Efforts to reduce readmissions must look beyond a single 30-day period.