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08 Nov

CMS and OMHA Broaden Appeal Settlement Options

On November 3rd, the Centers for Medicare and Medicaid Services announced on their website: “…CMS will make available an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.” The additional settlement option […]

09 Mar

CMS greenlights Performant, Region 1 RAC audit activity to begin this March

Performant Recovery Inc., the Region 1 & Region 5 Recovery Audit Contractor, has announced they have received approval from CMS to begin audit activity. As reported in a previous Cain Health Alert, Performant hinted that they would resume work again this March during their Provider Outreach webinars. On Wednesday, March 8, the formal announcement was made […]

23 Feb

New Rules for Governing Medicare Appeals Released by CMS

  The Center for Medicare Advocacy recently released an article detailing meaningful changes in a new final rule issued by the Centers for Medicare & Medicaid Services (CMS). The article shares a number of concerns with the new regulations which apply particularly to the Administrative Law Judge (ALJ) level of review. “The new regulations stated […]

17 Feb

Performant, NGS update Providers on new RAC contracts, other details

This week, National Government Services (FI/MAC) and Performant Recovery Inc. (RAC), held two webinars to introduce themselves and explain the Recovery Audit process to Providers. The RAC Regions were re-aligned as a result of the new Recovery Audit Contractor contracts and work is scheduled to resume this quarter for Performant, prompting a re-introduction. The webinars […]

06 Jan

With ACA Repeal Uncompensated Care Would Increase by $1.1 Trillion

A new study has suggested that a repeal of the Affordable Care Act – even a partial repeal – could lead to a dramatic increase in uncompensated care.  The report, published by the Urban Institute, finds that the increased amount would reach $1.1 trillion over a ten-year period. “The newly uninsured would seek $88.0 billion […]

12 Dec

US Healthcare Spending Reaches $10k Per Person

A new report from the Office of Actuary at the Centers for Medicare and Medicaid Services reveals that healthcare spending grew to $3.2 trillion dollars in the United States in 2015. This comes out to about $10,000 per person, a growth of rate of 5.8%. According to the report, published on HealthAffairs, the Affordable Care […]

01 Nov

Vermont Moves To All-Payer System

The state of Vermont has announced it received preliminary approval for its planned “all-payer” health care system. Governor Peter Shumlin has pushed for this new model as a means of addressing the rising costs of healthcare. The all-payer model would hold healthcare costs at an increase of 3.5 percent over ten years, purportedly saving Vermonters […]

18 Oct

Geisinger Health Systems Refunds Over $400K

Since rolling out a program in November 2015 that guarantees patients will receive a level of compassion and kindness with their medical care, Geisinger Health Systems has paid out more than $400,000 in refunds. According to a story in The Daily Item, the ProvenExperience initiative could easily top half-a-million dollars by the time it reaches […]

18 Oct

Reexamining Readmission Timeframes

A recent study published in Health Affairs suggests that a seven-day readmission interval may be a stronger indicator of quality care than the current measurement of thirty days. The study examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for patients ages sixty-five and older in four states. “The hospital-level quality signal […]