Editor's Note Medicare Advantage plans paid hospitals 8% less for hospital services than fee-for-service Medicare in 2009 and 2012, finds this study. Researchers also found that commercial insurers paid hospitals much higher than Medicare Advantage or fee-for-service Medicare. Some of this difference is because of higher prices commercial plans pay…

Read More

Despite warnings of calamities, implementation of the International Classification of Diseases (ICD)-10 on October 1, 2015, proceeded smoothly, with minimal impact on denied claims. In the fourth quarter of 2015, the percentage of Medicare claims denied was 10%, comparable to the preimplementation figure of 9.9%. But that doesn’t mean OR…

Read More

Editor's Note The Centers for Medicare & Medicaid Services on August 2 issued its final rule for the FY 2017 hospital inpatient prospective payment system (PPS), which increases rates by 0.95%. The 0.95% increase reflects the projected hospital market basket update of 2.7% for those hospitals that were meaningful users…

Read More

Editor's Note The Centers for Medicare and Medicaid’s (CMS) hospital readmission penalties will hit a new high over the next year as the government agency withholds more than half a million dollars in payments, the August 2 Kaiser Health News reports. CMS will punish more than half of US hospitals…

Read More

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 2 released its inpatient prospective payment system (PPS) final rule for FY 2017. In the rule, CMS kept a controversial 1.5% cut to hospital reimbursement, which aims to collect $11 billion in overpayments, the August 2 Modern Healthcare…

Read More

Editor's Note The Centers for Medicare & Medicaid (CMS) on July 27 released its Overall Hospital Quality Star Ratings of 3,617 hospitals. Only 102 received the top rating of five stars, and only a few of those are considered among the nation’s best, including Memorial Hermann Hospital System in Houston…

Read More

Editor's Note In a new study funded by the Agency for Healthcare Research and Quality (AHRQ), safety-net hospitals performed equally as well as other hospitals when evaluated according to medical-surgical mortality rates. Analyzing data from 1,891 hospitals in 31 states, researchers found that despite ongoing financial disadvantages, the quality of…

Read More

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 27 published its Overall Hospital Quality Star Ratings, the July 27 Modern Healthcare reports. The ratings, which are a composite metric of one to five stars, grade the quality of nearly 4,000 hospitals and are posted to the…

Read More

Editor's Note Implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) could threaten physicians’ autonomy in making decisions for their patients, provide burdensome levels of documentation, and pressure some solo and small practices to close, according to an analysis in the July 23 Medical Economics. MACRA also could contribute…

Read More

Editor's Note The Monticello Community Surgery Center, Charlottesville, Virginia, is posting prices of outpatient procedures on its website, the July 22 CBS 19 reports. The center’s CEO Andy Poole calls it the “wave of the future of healthcare.” Though the center takes insurance and Medicare, knowing the total cost of…

Read More