Medicare & Medicaid

Only 168 hospitals in the United States earned five stars in the latest Hospital Compare ratings from the Centers for Medicare and Medicaid Services, according to new data released last week.

Medicaid managed care programs remains vulnerable to improper payments to providers, according to a recent Government Accountability Report to a Senate Committee on Homeland Security and Governmental Affairs, since the information needed to screen providers for inclusion in the program is often fragmented and unavailable.

Just because it's hard to achieve a payer mix that better supports a health system's bottom line, it's not impossible.

Consultants hired by the health system that owns Nantucket Cottage Hospital in Massachusetts made several errors that led to lower wages being reported to Medicare for the hospital, which could potentially lead to a $160 million drop in federal Medicare payments over the next fiscal year for facilities across the state.

The delay will give CMS additional time to conduct focused consumer testing of how the star ratings are displayed on Healthcare.gov.

Insurers are picking up more of the cost of prescription pain drugs, according to a study linking that trend with the rise in opioid-related deaths.

1,900 women across the state were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California.

Changing the Medicare eligibility age from 65 to 67 years old would actually increase the nation's total healthcare spend since that two-year gap would be covered by private insurers that charge more for services than the federal government, according to a new report in Health Affairs.

The bonuses are small, generally a fraction of a percent of their Medicare payments. Nonetheless, rewarding hospitals of mediocre quality was hardly the stated goal when the Affordable Care Act created financial incentives to encourage better medical care from hospitals, doctors and other health care providers.

The plan takes into account feedback from 60 individuals and 150 organizations.