On August 17, 2018, the Centers for Medicare & Medicaid Services (CMS) published its Hospital Inpatient Prospective Payment Systems final rule for Fiscal Year 2019 (Final Rule). The Final Rule ...

The Centers for Medicare and Medicaid Services has announced that 14 communities have been chosen for the Agency’s Care Transitions Project, which seeks to eliminate unnecessary hospital re-admissions ...

CMS has issued more guidance related to its new regulation that generally considers inpatient admissions spanning two midnights as qualifying for payment under Medicare Part A. In terms of enforcing ...

We have identified a number of inconsistences with CMS's proposed collection of information for the new IRF RCD. First, the "Review Choice Demonstration for Inpatient Rehabilitation Facility Services" ...

Three insurers are denying long-term care requests at an unusually high rate, meaning some Medicare Advantage enrollees ...

Medicare Advantage, the privatized health insurance for Americans 65 years of age and older, is accounting for “a rising share of inpatient hospital days,” a KFF study released July 23, 2024 shows.

The government has made extensive efforts to combat fraud in the Medicare and Medicaid programs, recovering a record $4.2 billion in fiscal 2012 from individuals and companies trying to cheat the ...

Medical necessity determinations are not just a hot button issue with Recovery Audit Contractors RACs, but also with the other 'usual suspect' government auditors: Medicare administrative contractors ...

The federal agency that oversees Medicaid and Medicare is looking for an AI solution that helps predict and prevent unplanned hospital and nursing admissions, and it is dangling up to $1.65 million in ...

Exactly which doctor a patient ends up seeing in an emergency department can have a big impact on whether or not they get admitted to the hospital, according to a study recently published in Health ...