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Academic Journals
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From:Healthcare Financial Management (Vol. 56, Issue 2) Peer-ReviewedLess than two weeks before the scheduled implementation of the calendar year 2002 changes to the Medicare outpatient prospective payment system (PPS), the Centers for Medicare and Medicaid Services (CMS) announced that...
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From:National Tax Journal (Vol. 46, Issue 3) Peer-ReviewedThe federal government has successfully pursued a policy of preventing most states from imposing assessments upon Medicaid providers, but this policy will not prevent conflict between state financial burdens and federal...
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From:Healthcare Financial Management (Vol. 74, Issue 6) Peer-ReviewedA proposed CMS rule aims to lower administrative burdens and kick-start value-based payment arrangements for pharmaceuticals in Medicaid programs and commercial health plans. The June proposed rule would tweak federal...
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From:Hospitals & Health Networks (Vol. 71, Issue 22)What do you get when you arm a senior with the finer points of Medicare and Medicaid rules? A fraud buster--at least that's what the feds are betting on, to the tune of $2 million. That kitty is the initial cost of a...
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From:Health Services Research (Vol. 54, Issue 6) Peer-ReviewedObjective: To examine whether the Wellness Incentive and Navigation (WIN) intervention can improve health-related quality of life (HRQOL) among Medicaid enrollees with co-occurring physical and behavioral health...
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From:Healthcare Financial Management (Vol. 55, Issue 10) Peer-ReviewedStates using the pay-and-chase approach for handling Medicaid pharmacy payments are having little success in recovering payment from third parties, the HHS Office of Inspector General (OIG) announced in a report issued...
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From:Fordham Urban Law Journal (Vol. 43, Issue 1)2. Age-Based Restrictions May Conflict with Exceptions to the Doctrine of Informed Consent While the doctrine of informed consent may support age-based restrictions on gender-affirming treatment, the statutory...
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From:AJOT: American Journal of Occupational Therapy (Vol. 74, Issue S1) Peer-ReviewedPURPOSE: This study aimed to identify the number and boundaries of biclusters consisting of patient subgroups and their multimorbidities using visual analytics. This process intends to provide clinicians (e.g.,...
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From:AJOT: American Journal of Occupational Therapy (Vol. 74, Issue S1) Peer-ReviewedPURPOSE: Geographic variations exist in care use and health outcomes (Reistetter et al., 2015). Three tools currently available to examine geographic variations are Hospital Referral Regions (HRRs), Hospital Service...
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From:Child Protection Law Report (Vol. 30, Issue 18) Peer-Reviewed* In Medicaid Program Integrity: State and Federal Efforts to Prevent and Detect Improper Payments, GAO-04-707, the recently renamed General Accountability Office (GAO) summarizes the "various forms of fraud and abuse...
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From:AJOT: American Journal of Occupational Therapy (Vol. 73, Issue S1) Peer-ReviewedThis paper identifies the role and opportunities for the occupational therapy profession in Accountable Care Organizations (ACOs) and value-based care. Accountable Care Organizations are a popular alternative payment...
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From:Mayo Clinic Proceedings (Vol. 95, Issue 4) Peer-ReviewedThe Centers for Medicare and Medicaid Services (CMS) introduced 2 Current Procedural Terminology (CPT) codes that allow clinicians to bill for time spent discussing advance care planning (ACP) effective January 1, 2016....
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From:Healthcare Financial Management (Vol. 56, Issue 5) Peer-ReviewedThe Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the March 22, 2002, Federal Register to launch the new prospective payment system (PPS) for long-term care (LTC) hospitals. The new PPS,...
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From:Fordham Urban Law Journal (Vol. 39, Issue 3)INTRODUCTION After enrolling in the Illinois Medicaid program, the public health insurance program for poor and disabled Americans, Tessinia Rodriguez and Elissa Bassler both sought a physician referral from the...
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From:Family Practice News (Vol. 31, Issue 18)The Bush administration plans to offer states more options to expand coverage under Medicaid and the State Children's Health Insurance Program without increasing costs. To balance the expense, the Department of Health...
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From:PT in Motion (Vol. 11, Issue 10)In a problematic rule that is effective November 4, the Centers for Medicare and Medicaid Services has granted itself the power to deny or revoke enrollment In Medicare, Medicaid, and the Children's Health Insurance...
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From:Health Care Financing Review (Vol. 22, Issue 1) Peer-ReviewedThe history and current status of the Medicaid Home and Community-Based Services Waiver Program are presented. The article discusses the States' role in developing and implementing creative alternatives to institutional...
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From:Family Practice News (Vol. 32, Issue 1)The CMS has issued a proposal to limit a costly Medicaid "loophole." An earlier regulation let states make overall payments to hospitals not owned or operated by state government, at levels up to 150% of the estimated...
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From:Ophthalmology Times (Vol. 45, Issue 11) Peer-ReviewedEditor's Note: See related article on Page 1. Reimbursement and coding can be complicated in any specialty and ophthalmology is no exception. Working with products that fall into the pass-through" category from the...
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From:PT: Magazine of Physical Therapy (Vol. 17, Issue 5)The Centers for Medicare and Medicaid Services (CMS) recently released a final rule that could have implications for physical therapists who participate in their state Medicaid programs. The final rule establishes the...