Ten years – that’s how long the U.S. Department of Health and Human Services Office of Medicare Hearings and Appeals estimates the Medicare appeals backlog of 750,000 cases will take to clear.
Healthcare reform and the safety net: The rising tide
By
James Lomastro
Dec 06, 2013
Home- and community-based care advocates seek a total rebalance of care. They want the care dollars to be shifted to home- and community-based care, which has been historically short-shifted. However,...
Have we not been through this before?
By
James Lomastro
Sep 16, 2013
Recently, the former head of the Centers for Medicare & Medicaid Services indicated that the agency should scrap a rule requiring three days as a hospital inpatient to qualify for Medicare coverage of...
‘The Great Perhaps’ in LTC
By
Tara Roberts
Jul 18, 2014
In post-acute care, particularly the SNF future, it can be “Great” but there are so many “Perhaps” that the definition of what “Great” is going to be is unclear.
The Five Star Report, once again, in the SNF spotlight
By
Steven Littlehale
Sep 24, 2014
The Five Star Quality Rating System takes the spotlight on the front page of the New York Times and the top of the news cycle, kicking off other publicity and political pressure. Regardless of any of the...
To help elderly patients, CMS should prohibit PBM fees – not reform them
By
Alan G. Rosenbloom
Feb 16, 2018
Over just the past few years, the nation’s three largest pharmacy benefit managers (PBMs) – CVS Caremark, Express Scripts and Optum Rx – have come to control more than 80% of prescriptions...
Payment reform: Ready! Set! Don’t go! No, I mean go!
By
Steven Littlehale
Apr 23, 2018
Perhaps you think that the new therapy-payment bombshell (RCS-1) has turned out to be a dud. I hope to make the point that it was not.
The importance of data accuracy
By
Steven Littlehale
Apr 10, 2013
Has a day gone by when you haven’t heard about a new healthcare reform requirement coming of age? This month skilled nursing facilities were supposed to have started having an operational compliance...
What’s in a name?
By
Tara Roberts
Mar 04, 2015
The new name of the American Coalition for Healthcare Claims Integrity is the Council for Medicare Integrity. Does that mean they’ll change their focus? Not quite.
2016: Taking stock so far
Apr 15, 2016
We are playing a bigger role in helping shift the view from seniors requiring treatment of an illness to that of a life lived that is full of exercise, activities and whole-person wellness.