Reimbursement

It’s been estimated that fraud adds as much as $60 billion a year to our healthcare costs. Well, the problem has gotten the attention of the Office of the Inspector General (OIG) which is tasked with protecting the integrity of the Medicare and Medicaid programs and the health and welfare of program beneficiaries.

Healthcare reform could close the gap between recommendations of the U.S. Preventive Services Task Force, charged by the government to review clinical preventive health services for older adults, and Medicare coverage for those services, according to a new study.

The Medicare Payment Advisory Commission voted last week to recommend to Congress a 1 percent increase in Medicare hospital inpatient and hospital outpatient prospective payment system rates for 2012, in addition to a 1 percent pay rate increase for physicians.

Medicare coverage for home care visits has a checkered history. The original rationale for including home care in Medicare was straightforward and compelling: it's much cheaper, healthier and pleasant for a patient to be at home receiving skilled care than to stay in a hospital for lack of enough support in the home environment.

MEDecision published an e-book Tuesday, Medical Loss Ratios: Important Implications for Care Management, which examines the impact new Health and Human Services mandates will have on care delivery models - and explores the critical role of health IT as health plans work to meet the new requirements.

Hospitals hiring physicians as employees and primary care physicians receiving financial incentives for patients who do well are among the 2010 healthcare trends cited in a new industry report from staffing firm Jackson & Coker.

Insurers have drawn the ire of government officials by announcing that the new health care law would force them to raise premiums. "I want health insurance companies to be transparent and honest when increasing premiums," Sen. Jay Rockefeller, D-W.Va., declared.  

A new nationwide poll shows that 65 percent of Americans would oppose further cuts to funding for long term care.

Paul LePage, Maine's new Republican governor, has submitted a supplemental budget to the Legislature that includes paying back nearly $250 million owed to hospitals for overdue Medicaid charges.

Paul LePage, Maine's new Republican governor, has submitted a supplemental budget to the Legislature that includes paying back nearly $250 million owed to hospitals for overdue Medicaid charges. "It's purely a very fiscally responsible budget," LePage said during a Thursday press conference releasing the budget. "It addresses fiscal responsibility, saving jobs in healthcare and simplifying the tax codes."