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Academic Journals
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From:Physician Leadership Journal (Vol. 6, Issue 6) Peer-ReviewedAs Medicare enrollment grows and the dynamic Medicare Advantage program continues to evolve, provider systems will need to continuously evaluate how they are positioned and what strategies they can implement to...
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From:Healthcare Financial Management (Vol. 71, Issue 7) Peer-ReviewedPart B drugs are making news, again, despite the decision of the Centers for Medicare & Medicaid Services (CMS) to withdraw its planned pilot projects for Part B Medicare--or perhaps because of that decision. The...
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From:Healthcare Financial Management (Vol. 70, Issue 8) Peer-ReviewedOutpatient facilities that have been rebuilt or relocated off-campus would no longer qualify for hospital-level payment from Medicare, under payment changes proposed this week. The outpatient department payment changes...
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From:Health Services Research (Vol. 54, Issue 5) Peer-ReviewedObjective: To examine the relationship between insurer market structure, health plan quality, and health insurance premiums in the Medicare Advantage (MA) program. Data Sources/Study Setting: Administrative data files...
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From:Trial (Vol. 49, Issue 9)The SMART Act improves the Medicare Secondary Payer process in many ways, but it contains some limitations. You need to know how to use the act to your advantage and navigate its hurdles. Have you ever had the...
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From:AJOT: American Journal of Occupational Therapy (Vol. 74, Issue S1) Peer-ReviewedPURPOSE: The Centers for Medicare and Medicaid Services mandate the collection of rehabilitation therapy utilization data to improve the quality of care and accuracy of payments (Centers for Medicare Medicaid Services,...
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From:Review of Optometry (Vol. 138, Issue 4) Peer-ReviewedThe Senate is taking up legislation that would address optometry's concerns about Medicare documentation guide lines, conflicting regulations between state carriers and the federal government, and sanctions for...
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From:Drugs (Vol. 69, Issue 4) Peer-ReviewedIn the US, the Medicare Modernization Act of 2003 required that Medicare Part D insurers provide medication therapy management (MTM) services (MTMS) to selected beneficiaries, with the goals ofproviding education,...
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From:Healthcare Financial Management (Vol. 64, Issue 7) Peer-ReviewedWhen CMS adopted the Medicare severity diagnosis-related groups (MS-DRGs) in 2008, their purported intent was to find a more accurate way to pay hospitals for treating patients with the most resource-intensive medical...
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From:Healthcare Financial Management (Vol. 58, Issue 5) Peer-ReviewedMuch ink has already been spilled extolling t he perceived virtues--and vices--of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) in general and of private delivery in particular. Most...
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From:Healthcare Financial Management (Vol. 59, Issue 9) Peer-ReviewedA new Medicare demonstration project is under way in three states in which recovery audit contractors are reviewing old Medicare claims to discover overpayments and demand their repayment from providers. The RACs, which...
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From:Ostomy Quarterly (Vol. 38, Issue 2) Peer-ReviewedI have such wonderful news to share with all of you. The Health Care Financing Administration and their contractors known as the Durable Medical Equipment Regional Carriers (DMERCs) have adopted the recommendations from...
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From:Healthcare Financial Management (Vol. 55, Issue 7) Peer-ReviewedProviders who understand the outpatient code editor will save considerable time and effort when trying to follow billing and coding procedures for the outpatient prospective payment system. Since implementation of...
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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:Healthcare Financial Management (Vol. 70, Issue 11) Peer-ReviewedThe much-anticipated final rule implementing the Medicare physician payment overhaul features several changes from a previously proposed version, including plans for new alternative payment models (APMs). The final...
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From:Family Practice News (Vol. 31, Issue 5)Frieden, Joyce Most of the $6.2 billion in federal funds authorized to stimulate HMO participation in Medicare will go to doctors and hospitals, a decision that angered Rep. Pete Stark (D-Calif), who wants HMOs to...
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From:Health Services Research (Vol. 53, Issue 4) Peer-ReviewedObjective. To determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. Data Source. Inpatient Rehabilitation Facility-Patient...
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From:Health Care Financing Review (Vol. 26, Issue 3) Peer-ReviewedBeginning January 2006, Medicare beneficiaries will have limited ability to change health plans. We examine the Medicare managed care enrollment and disenrollment behavior of traditionally vulnerable beneficiaries from...
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From:Health Services Research (Vol. 51, Issue 5) Peer-ReviewedObjective. To understand what patterns of health care use are associated with higher post-hospitalization spending. Data Sources. Medicare hospital, skilled nursing, inpatient rehabilitation, and home health agency...
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From:Archives of Pathology & Laboratory Medicine (Vol. 144, Issue 6) Peer-ReviewedThe development of the Medicare Access and the Children's Health Insurance Program Reauthorization Act of 2015 (MACRA) was ultimately the result of the Centers for Medicare and Medicaid Services (CMS) reflecting on how...