Medicare & Medicaid

A new report from the Center for Improving Value in Health Care reveals significant variation in payments in Colorado for hip and knee replacements between private health insurance payers and Medicare: Coloradans with private insurance in the northeast pay $55,000 more than their neighbors with Medicare, while those in Denver pay $17,000 over Medicare prices.

The Centers for Medicare and Medicaid Services has announced access to preferred cost-sharing pharmacies has improved, with the bottom 10 percent of plans so far this year offering access within two miles of 71 percent of urban beneficiaries. That's compared to 40 percent of beneficiaries who had similar geographic access in 2014.

The Centers for Medicare and Medicaid Services on Thursday published a final rule that requires healthcare providers to repay overpayments discovered within six years of the initial Medicare reimbursement, a significantly shorter lookback period than first proposed.

In December 2014, Medicare began a pilot program in three states, including Pennsylvania, to cut down on what officials believed were improper payments, including some possible fraud and abuse, in nonemergency ambulance services. The program moved to more aggressively enforce Medicare's long-standing policy requiring that beneficiaries be so weak they could only be moved on a stretcher before it would pay for repeated, nonemergency ambulance service.

After years of losing money, River's Edge Hospital in St. Peter, Minnesota posted a profitable 2015 and is considering expanding the facility, an uncommon story for a rural, critical-access hospital.

The Centers for Medicare and Medicaid Services has proposed new rules it expects will expand access to analysis and data that helps employers and providers make more informed decisions about care delivery.

The Centers for Medicare and Medicaid Services on Thursday said it will begin taking regional differences into account when measuring the performance of accountable care organizations in the Medicare Shared Savings program, one of several changes announced to the benchmark guidelines in the program.

Hospitals in Medicaid expansion states fare better financially than those in states that have not adopted the Affordable Care Act initiative, according to an attorney who formerly directed the Medicaid program for the Centers for Medicare and Medicaid Services.

With the final January 31 deadline for open enrollment looming, close to 9 million consumers have signed up for healthcare coverage through the marketplace, according to the Centers for Medicare and Medicaid Services.

Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions.