posts tagged as Medicaid


Hospitals: How a Proposed CMS Rule Would Adjust HRRP Penalties by Proportion of Dual-Eligible Patients

CMS recently proposed a rule that would serve as a first step in creating a more level playing field for safety-net hospitals under value-based reimbursement. Our new alert explains how the rule would group hospitals, and what you need... read more


By Susan C. Sargent | March 09, 2017

2017 CMS Physician Fee Schedule Important Step Toward Achieving Population Health

On Nov. 2, 2016, the 2017 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule was finalized, reflecting, among other changes, an emphasis on primary care efforts to drive enhanced care management and behavioral health... read more


The Best-Kept Healthcare Secret

We've seen the future of healthcare in America, and it's called PACE. The PACE (Program for All-inclusive Care for the Elderly) integrates preventive, primary, acute, behavioral and long-term services for people at least 55 years old who... read more


By Venson Wallin | January 26, 2017

2 Compliance Takeaways from the 21st Century Cures Act

On Dec. 13, President Obama signed the 21st Century Cures Act (the Cures Act) into law, boosting healthcare research dollars, streamlining the Food and Drug Administration (FDA)’s drug and medical device approvals processes, and... read more


Supreme Court Ruling on the False Claims Act: Providing Whistleblowers a Wider Net?

When it comes to quality-based reimbursements, healthcare organizations face greater compliance risk, and the recent Supreme Court decision to uphold the “implied false certification” theory of liability under the False Claims Act (FCA... read more


By Steven Shill | April 12, 2016

Lost in Translation: The Challenges of Integrating Medicaid Managed Care into Commercial Insurer Portfolios

For commercial insurers adding governmental payer managed care plans to their portfolios, ‘lost in translation’ moments can be costly. read more


By Venson Wallin | February 05, 2016

How Are Changing Reimbursement Models Impacting Risk? 7 Questions to Address This Quarter

Healthcare providers are starting to feel the impact of the accelerating pace of reimbursement changes. Delivery models are transforming, ushering in new opportunities and risks that organizations must manage.  read more


By Patrick Pilch | November 03, 2015

Infographic: Healthcare Leaders Take on DSRIP Workforce Strategy

Many U.S. healthcare providers are preparing for an organizational overhaul, including implementation of Delivery System Reform Incentive Payment (DSRIP) programs. read more


Seeing Medicaid Providers As Behavioral Health Investment Opportunities

Private equity investment in behavioral health has historically been limited to practices that cater to self-pay individuals or to the well-insured. Indeed, the term “treatment center,” to some, even conjures up images of spa... read more


By William Bithoney | October 02, 2015

340B Program Guidance Finally Sets Sail

For several years, hospital administrators and clinicians have been anxiously awaiting proposed new “mega” regulations affecting the federal 340B drug program. After hitting a bump in the road earlier this year, the Health... read more