Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care
By
Josh Henreckson
Jun 26, 2024
The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional...
CMS sends update on $75M nursing home recruitment campaign, but providers’ concerns linger
By
Josh Henreckson
Jun 13, 2024
CMS’ admitted lack of a plan thus far for the $75 million it intends to use to spur development of more nursing home workers is further puncturing providers’ hopes for helpful change.
CMS finalizes long-awaited prior authorization rule for Medicare Advantage
By
Josh Henreckson
Jan 18, 2024
A new rule on Medicare Advantage prior authorization finalized by the Centers for Medicare & Medicaid Services Wednesday suggests good news for providers and Medicare recipients.
CMS delivers providers payment lifelines in the wake of Change Healthcare outage
By
Josh Henreckson
Mar 12, 2024
Federal regulators are opening pathways to shore up nursing homes’ finances in the wake of a cyberattack that has impacted Medicare and Medicaid billing nationwide.
Aging committee chair delivers another broadside about nursing home surveys
By
Jessica R. Towhey
Jul 28, 2023
A powerful US senator is bringing added firepower in his quest to fix what he sees as major issues with state surveys of nursing homes. It’s an effort that had one leading advocate channeling Alanis...
HHS chief returns focus of low COVID-19 vax rates to nursing homes
By
James M. Berklan
Jan 04, 2024
The nation’s top health official met with US nursing home leaders for the second time in two weeks Wednesday to discuss what he called concerningly low COVID-19 vaccination rates among long-term care...
CMS 5-claim audits so far a ‘debacle’
By
Jessica R. Towhey
Aug 22, 2023
A new federal review process designed to lower the rate of improper government payments is sending provider staffs scurrying to justify their coding.
CMS provides first look at shorter, Risk-Based Survey process
By
Kimberly Marselas
Apr 04, 2024
The Centers for Medicare & Medicaid Services on Wednesday revealed initial information about a potential “Risk-Based Survey” option that could be available to some of the nation’s best performing...
CMS proposes appeals process for Medicare patients placed on observation stay
By
Josh Henreckson
Jan 02, 2024
Medicare patients initially admitted to hospitals as inpatients but later reclassified as outpatients under observation would finally have a process to appeal those decisions, thanks to a long-awaited...
Medicare Advantage plan settles upcoding allegations for $22.5M
By
Kimberly Marselas
Aug 02, 2023
A Medicare Advantage plan will pay $22.5 million to settle allegations that it systematically reviewed patient charts to tack on additional charges before submitting claims to Medicare, federal law enforcement...