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1. Long Term Care Share of Cost Providers receiving an eligibility verification message (see following example) that indicates a subscriber has an LTC SOC should not  clear the SOC online.  Subscribers with aid codes 13, 23, 53 and 63 must have their LTC SOC cleared on the claim.  The LTC facility  includes the LTC SOC amount for Medi-Cal-covered services on the  Payment […]...
2. Analysis of Medicare Advantage HMOs Compared With Traditional Medicare Shows Lower Use of Many Services Analysis of Medicare Advantage HMOs Compared With Traditional Medicare Shows Lower Use of Many Services ...
3. Share of Cost: 91 People Charged for Fraudulently Billing Medicare $295 Million Have you heard about last week’s arrests in a historic takedown by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Strike Force? This takedown happened in 8 cities and has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately […]...
4. Medicare And Medicaid Spending Variations are Strongly Linked Within Hospital Regions But Not at Overall State Level Medicare And Medicaid Spending Variations are Strongly Linked Within Hospital Regions But Not at Overall State Level...
5. Share of Cost, Innovations At Miami Practice Show Promise For Treating High-Risk Medicare Patients Share of Cost, Innovations At Miami Practice Show Promise For Treating High-Risk Medicare Patients ...
6. Certifying Share of Cost Benefits and Coverage Subscribers are not eligible to receive Medi-Cal benefits until their monthly Share of Cost dollar amount has been certified online. Certifying SOC means that the Medi-Cal eligibility verification system shows the subscriber has paid or become obligated for the entire monthly dollar SOC amount owed. Claims submitted for services rendered to a subscriber whose SOC […]...
7. Share of Cost, CMS Offers New Safeguards and Incentives in Preventing Medicare Fraud Share of Cost, CMS Offers New Safeguards and Incentives in Preventing Medicare Fraud...
8. Share of Cost, Additional Reductions In Medicare Spending Growth Will Likely Require Shifting Costs To Beneficiaries Share of Cost, Additional Reductions In Medicare Spending Growth Will Likely Require Shifting Costs To Beneficiaries ...
9. State Spending on Dual Eligibles Under Age 65 Shows Variations, Evidence Of Cost Shifting From Medicaid To Medicare State Spending on Dual Eligibles Under Age 65 Shows Variations, Evidence Of Cost Shifting From Medicaid To Medicare...
10. Medicare Postacute Care Payment Reforms Have Potential to Improve Efficiency of Care, But May Need Changes to Cut Costs The Affordable Care Act mandates changes in payment policies for Medicare postacute care services intended to contain spending in the long run and help ensure the program’s financial sustainability. In addition to reducing annual payment increases to providers under the existing prospective payment systems, the act calls for demonstration projects of bundled payment, accountable care […]...
11. Share of Cost, Large Increases In Spending On Postacute Care In Medicare Point To The Potential For Cost Savings In These Settings Share of Cost, Large Increases In Spending On Postacute Care In Medicare Point To The Potential For Cost Savings In These Settings ...
12. Several Medicare Cost Changes for New Beneficiaries in the President’s Budget Proposal Several Medicare Cost Changes for New Beneficiaries in the President’s Budget Proposal...
13. How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations [Payment & Delivery] The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers […]...
14. Share of Cost, Public Financing Of The Medicare Program Will Make Its Uniform Structure Increasingly Costly To Sustain Share of Cost, Public Financing Of The Medicare Program Will Make Its Uniform Structure Increasingly Costly To Sustain ...
15. Lessons For The New CMS Innovation Center From The Medicare Health Support Program The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS’s role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program […]...