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The Centers for Medicare and Medicaid Services should update its county benchmark calculation in the 2019 final notice being published April 2.

“America’s Health Insurance Plans is asking the Centers of Medicare and Medicaid Services to change the way the agency calculates Medicare Advantage payment rates, ahead of a final notice due out Monday. AHIP said it strongly believes CMS should update its benchmark calculation in the 2019 final notice. These reflect spending for enrollees with only Medicare Part A for care in hospitals and other facilities, enrollees with only Medicare Part B, which covers physician visits and medical supplies and enrollees with both Medicare Parts A and B. This method captures the expenditures of all Medicare beneficiaries, regardless of whether they’re in Part A, B or both. MA plans are required to provide coverage for all services included under both Parts A and B. AHIP said the cost data for beneficiaries who are only in Medicare Part A – for hospitalization – should be excluded from calculating MA payment rates. The Medicare Payment Advisory Commission has also recommended that CMS revise the calculation of benchmarks.” Read the full article.

The funding is to develop partnerships with health systems, clinicians and others to improve measures in the quality payment program of MACRA.

“The Centers for Medicare...

For individuals who have Medicare, they have recently had the opportunity to enroll in a 2018 Medicare Advantage or other Medicare plan, review their current coverage, or change plans.  Health plans across the country are evaluating their successes and opportunities for improvement from the recently closed Open Enrollment Period.

The agency’s Innovation Center said the new Bundled Payments for Care Improvement Advanced model is the first APM that would qualify under MACRA.

“The Centers for...

The use of a claims analytics platform helped Medicare to identify and prevent millions of dollars in provider fraud.

“Close to a quarter of new Medicare fraud...

A new report by HHS’ Office of Inspector General gives CMS points for making significant efforts to implement the Quality Payment Program (QPP) but says challenges...

Healthcare Dive Brief

“Medicaid programs in 48 states and the District of Columbia reimburse for some form of live video encounters, the Center for Connected Health...

Lack of productivity and increased workload among top complaints from providers surveyed

The report highlights ACOs’ experience by evaluating proficiency across key activities, educating organizations about the importance of key activities and prioritizing...