BY THOMAS BEATON: Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.
The Office of the Inspector General, along with other federal law enforcement entities, have recently acted against a number of individuals accused of defrauding the system. (read more)
BY MATTHEW FRANKEL: Medicare provides health coverage for millions of older Americans, but many future and current beneficiaries don’t understand many of the program’s basic features. With that in mind, here are 12 frequently asked Medicare questions and what you need to know about each one. (read more)
BY STACEY BURLING: A typical senior with a Medicare Advantage plan has access to just 43 percent of physicians in his or her county, a new analysis by the Kaiser Family Foundation has found.
Kaiser on Thursday released what it said was the first study to compare the size of networks available without extra fees to Medicare Advantage subscribers, said lead author Gretchen Jacobson, a health economist and expert in Medicare, the government insurance program for seniors and the disabled. (read more)
BY MARK MCCLELLAN AND MIKE LEAVITT: The economic imperative for better health care at a lower cost has never been more urgent. Changing the way that health care providers are paid is at the core of solving the problem. Bipartisan support has formed around the idea of flexibility and innovation in how care is delivered in conjunction with more accountability for results. But the journey toward implementing these new models of care and payment is a difficult one.
Success in these reforms means moving away from relying only or primarily on fee-for-service payments. The Centers for Medicare and Medicaid Services and, by extension, private payers rely on a highly complex system of fee-for-service prices. More than 47,000 different prices are listed for covered health care services, while many services and interventions that could lower costs and improve care — such as team-based approaches to care, telemedicine, and digital health services, personalized services based on new diagnostics and big-data capabilities, or spending time with a patient to develop a care plan that reflects their preferences — aren’t covered much or at all. Medicare prices are determined by thousands of pages of regulation and legislation. (read more)
BY CHARLIE HUTCHINSON: Medicare’s Chronic Care Management (CCM) program does not specifically reimburse non-physician practitioners, and thus, seemingly excludes much of the behavioral health community. The program has enjoyed success since its 2015 introduction and was expanded in 2017, which presents some unique and exciting opportunities for behavioral health providers.
Along with the expansion of the CCM program, the Centers for Medicare and Medicaid Services (CMS) also introduced an expanded code set for the psychiatric Collaborative Care Model (CoCM) and Behavioral Health Integration (BHI) programs. As of January 1, 2017, CMS began directly reimbursing clinicians who coordinate care for patients with behavioral health conditions. Although reimbursements in these models still favor primary care practices, they are yet another small, but positive step on the journey to more tightly integrate the general medical and behavioral health communities. (read more)
Medicare doesn’t cover everything. Luckily, those on Medicare can now start saving on out of pocket expenses like prescription drugs, dental, vision, hearing, and more. Over 1 million people have already received their free Medicare Plus Card.(Read More...)