This past September our virtual Jimmo Symposium brought together advocates, providers, beneficiaries, and others to discuss practical tips and strategies for obtaining medically necessary services pursuant to the Jimmo settlement, as well as ongoing … [Read more...] about Know Jimmo | Watch our Symposium to hear from Jimmo Pros
Weekly Alert
Information Requested on “Corporate Greed in Health Care”
The Federal Trade Commission and the Departments of Justice and Health and Human Services have “launched a cross-government public inquiry into private-equity and other corporations’ increasing control over health care.” They held a joint virtual … [Read more...] about Information Requested on “Corporate Greed in Health Care”
CMS Must Preserve Standard Surveys for All Nursing Facilities
In an April 2024 Update, the Centers for Medicare & Medicaid Services (CMS) describes a risk-based survey (RBS) that it is testing to provide shorter, “more focused” surveys for “consistently higher-quality facilities.” CMS does not describe the … [Read more...] about CMS Must Preserve Standard Surveys for All Nursing Facilities
Medicare Advantage Payment Rates for 2025 Released
CMS Holds the Line Against Insurance Industry Pressure, but Plans Remain Significantly Overpaid.As discussed in recent CMA Alerts (see, e.g., here and here), in late January this year the Centers for Medicare & Medicaid Services (CMS) issued … [Read more...] about Medicare Advantage Payment Rates for 2025 Released
Study Examines Health Equity Differences between Medicare and Medicare Advantage
A recent Health Affairs study, Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups, examined gaps in quality of care when comparing traditional Medicare and Medicare Advantage for … [Read more...] about Study Examines Health Equity Differences between Medicare and Medicare Advantage
CMS Proposes Major Changes to Civil Money Penalties for Nursing Homes
As part of the annual update to Medicare Part A payments to skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) proposes significant changes to the civil money penalty (CMP) system for nursing homes. The Center for … [Read more...] about CMS Proposes Major Changes to Civil Money Penalties for Nursing Homes
Know Jimmo | Use the CMS Information
CMS says very clearly that "skilled nursing and skilled therapy services in the Skilled Nursing Facility (SNF), Home Health (HH), and Outpatient Therapy (OPT) settings does not turn on the presence or absence of a beneficiary’s potential for … [Read more...] about Know Jimmo | Use the CMS Information
Report on Improper Payments Shows Billions Wasted on Private Medicare Plans
The General Accounting Office (GAO) released a report on March 26, 2024 outlining payments that should not have been made, or were made in improper amounts by various government agencies. In its report, the GAO splits out payments in the … [Read more...] about Report on Improper Payments Shows Billions Wasted on Private Medicare Plans
MedPAC Report Undermines Nursing Home Industry Claims
In its March 2024 policy report, the Medicare Payment Advisory Commission (MedPAC), the independent government agency that advises Congress on Medicare policy, recommends a reduction of 3% in payments to skilled nursing facilities in the traditional … [Read more...] about MedPAC Report Undermines Nursing Home Industry Claims
Medicare Drug Pricing Updates from HHS
This week the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the list of 41 drugs available through Medicare Part B that will have a lowered Part B coinsurance rate from April … [Read more...] about Medicare Drug Pricing Updates from HHS