Medisys Compliance

JANUARY 29, 2025

Add in the complexities of Medicare and Medicaid, and it can feel overwhelming. This article will explore how outsourcing cardiology billing for Medicare and Medicaid can streamline your operations, boost revenue, and free you to focus on delivering exceptional cardiac care.

Medicaid 59

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HealthIT Answers

APRIL 3, 2025

By Lauren Barca, MHA, RN - The headlines for 2025 Medicare, Medicaid, and dual-eligible programs are rife with concerns about proposed changes. While those worries were certainly a topic of discussion at AHIPs recent Medicare, Medicaid, Duals, and Commercial Markets Forum in Baltimore, Maryland, they werent the only story.

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HIT Consultant

MARCH 11, 2025

– The solution aims to help Medicare Advantage plans improve their TRC Star measure performance by automating the access and delivery of critical admission and discharge information. The new solution addresses the significant issue of hospital readmissions among Medicare beneficiaries. billion annually.

Medicare 99

Medicare Medicare Medicaid Medicaid 99

Healthcare It News

APRIL 15, 2022

Postal Service and an online account this summer to connect with Medicaid enrollees about the expected end of the covid public health emergency, which will put many recipients at risk of losing their coverage. State Medicaid agencies for months have been preparing for the end of the public health emergency.

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Medicaid Medicaid US Department of Health and Human Services COVID-19 261

Healthcare It News

MARCH 30, 2022

Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic. "Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report.

Medicare 293

Medicare Medicare US Department of Health and Human Services COVID-19 293

Healthcare Dive

FEBRUARY 13, 2025

House Republicans unveiled their budget wish list on Wednesday, which directs the Energy and Commerce Committee — which oversees Medicare and Medicaid — to find $880 billion in savings.

Medicaid 363

Medicaid Medicaid Medicare Medicare 363

Healthcare IT Today

APRIL 4, 2025

Translation of member materials is an onerous burden for Medicare Advantage Organizations (MAOs). For Dual Special Needs Plans (DSNPs), compliance is even more complex as they must meet both Medicare and Medicaid translation requirements, supporting as many as 24 languages in some states.

Medicare 84

Medicare Medicare Medicaid Medicaid 84

Fierce Healthcare

NOVEMBER 26, 2024

The Centers for Medicare & Medicaid Services (CMS) is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov.

Medicaid 127

Medicaid Medicaid Medicare Medicare 127

Healthcare IT News - Telehealth

FEBRUARY 22, 2024

Brightside Health will be entering into new and expanded payer partnerships to support telemental healthcare access through Medicare and Medicaid, teaming with companies such as Blue Shield of California, CareOregon and Centene.

Medicaid 153

Medicaid Medicaid Medicare Medicare 153

Healthcare Dive

JULY 10, 2024

The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards in a bid to improve maternal mortality.

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Hospitals Medicare Medicare Medicaid 282

Healthcare Dive

AUGUST 23, 2023

Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicare coverage without proper notice.

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Medicaid Medicaid Medicare Medicare 246

HIT Consultant

DECEMBER 23, 2024

Brian Norris, Managing Director of Strategic Consulting at MedeAnalytics There are almost 33 million people enrolled in eligible Medicare programs. Nearly half are enrolled in Medicare Advantage (MA) plans, and that number is expected to continue its climb.

Health Outcomes 97

Health Outcomes Medicare Medicare Patient Satisfaction 97

Healthcare Dive

SEPTEMBER 11, 2024

Though CVS Caremark holds a dominant share of the commercial, Medicare Part D and Medicaid managed care markets, each large pharmacy benefit manager seems to be focusing on one particular arena.

Medicaid 313

Medicaid Medicaid Medicare Medicare 313

Fierce Healthcare

SEPTEMBER 27, 2024

Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries of | A new report from HHS OIG looked at access to medication for opioid use disorder services and found many high need counties do not have specialized providers. (..)

Medicaid 128

Medicaid Medicaid Medicare Medicare 128

Healthcare Dive

SEPTEMBER 16, 2024

The Illinois-based pharmacy giant has agreed to pay almost $107 million to settle claims it billed Medicare, Medicaid and other government programs for prescriptions that were never dispensed.

Medicaid 301

Medicaid Medicaid Medicare Medicare 301

MRO Compliance

FEBRUARY 26, 2025

Likewise, payers are mandated by the Centers for Medicare & Medicaid Services to make member data available to external stakeholders via application program interfaces. Clinical data is a two-way street for payers. These organizations require timely and accurate patient data from their healthcare provider partners.

Medicaid 147

Medicaid Medicaid Medicare Medicare 147

Healthcare IT News - Telehealth

JANUARY 11, 2023

The Kaiser Family Foundation recently looked at state trends with regard to expanding access to telehealth-based behavioral care during the pandemic and found that states see telemedicine as a key component of maintaining access to behavioral healthcare for Medicaid enrollees. WHY IT MATTERS. ON THE RECORD.

Medicaid 182

Medicaid Medicaid Medicare Medicare 182

Healthcare Dive

APRIL 19, 2023

The payer said it was pleased with the recent CMS decision to phase in risk adjustment changes to the Medicare Advantage program that would allow it to “smooth the impact” to beneficiaries and providers.

Medicaid 246

Medicaid Medicaid Medicare Medicare 246

Medisys Compliance

MARCH 9, 2025

Understanding Medicare coverage for counseling can feel particularly challenging, but it is crucial. Many providers find themselves asking: What exactly does Medicare cover when it comes to outpatient mental health counseling services? This cornerstone of outpatient mental health care is generally well-covered by Medicare.

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Medicare Medicare Medical Billing Medical Billing Services 59

Fierce Healthcare

NOVEMBER 3, 2024

Under a final rule issued by the Centers for Medicare and Medicaid Services, outpatient hospital facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from | Under a final rule issued by CMS, outpatient hospital facilities and ambulatory surgical centers will get a 2.9%

Medicare 125

Medicare Medicare Medicaid Medicaid 125

Healthcare Dive

SEPTEMBER 29, 2023

The Congressional Budget Office report estimated the Center for Medicare and Medicaid Innovation, which was created in part to reduce spending, will increase net federal spending by $1.3 billion from 2021 through 2030.

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Medicaid Medicaid Medicare Medicare 307

Healthcare Dive

DECEMBER 15, 2022

Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.

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Medicaid Medicaid Medicare Medicare 293

Fierce Healthcare

AUGUST 15, 2024

The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations. | The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations.

Medicare 135

Medicare Medicare Medicaid Medicaid 135

Healthcare Dive

NOVEMBER 8, 2023

Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s. Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics?

Health Insurance 270

Health Insurance Medicaid Medicaid Medicare 270

Healthcare It News

APRIL 29, 2024

One way hospitals dealt with staffing shortages and the need for beds during COVID-19 was to use flexibilities allowed by the Centers for Medicare and Medicaid Services to treat acute care patients at

COVID-19 261

COVID-19 Medicaid Medicaid Nurses 261

Fierce Healthcare

APRIL 22, 2024

The Centers for Medicare & Medicaid Services is hoping to improve Medicaid enrollees’ access to care through a final rule that better compensates caregiving roles. | CMS released a series of final rules Monday, including Medicaid access regulations that some groups worry will cause providers to close.

Medicaid 127

Medicaid Medicaid Medicare Medicare 127

Fierce Healthcare

OCTOBER 29, 2024

Accountable care organizations saved Medicare $2.1 billion, the largest yearly savings in program history, in 2023, the Centers for Medicare & Medicaid Services revealed on Tuesday. Accountable care organizations (ACOs) saved Medicare $2.1

Medicare 130

Medicare Medicare Medicaid Medicaid 130

Fierce Healthcare

JUNE 13, 2024

The Centers for Medicare & Medicaid Services (CMS) appears poised to rework Medicare Advantage (MA) quality ratings for this year, The Wall Street Journal

Medicare 127

Medicare Medicare Medicaid Medicaid 127

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. |

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Medicare Medicare Doctors Medicaid 131

Bill of Health

NOVEMBER 12, 2024

Policy Solution #1: State Medicaid Expansion Expanding Medicaid in Alabama could bolster the finances of rural hospitals, which currently bear the substantial costs of uncompensated care for uninsured patients. However, Alabama’s political leadership remains resistant to Medicaid expansion. Senator Katie Britt (R-AL).

Medicaid 113

Medicaid Medicaid Hospitals Health Outcomes 113

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 119

Medicare Medicare Medicaid Medicaid 119

Healthcare Dive

DECEMBER 4, 2023

The HHS’ Office of the Inspector General’s report tallied 707 criminal enforcement actions and 746 civil actions for fraud and misspent funds in programs like Medicare and Medicaid.

Fraud 246

Fraud Governance Medicaid Medicaid 246

Healthcare IT News - Telehealth

JUNE 19, 2023

Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

Medicare 172

Medicare Medicare Telemedicine Medicaid 172

Bill of Health

OCTOBER 17, 2024

This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 125

Medicare Medicare Medicaid Medicaid 125

Fierce Healthcare

DECEMBER 17, 2024

The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025. | The Value-Based Insurance Design model for Medicare Advantage plans will be terminated at the end of next year.

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Medicare Medicare Medicaid Medicaid 125