CMS Fraud Waste and Abuse 2016: Make Sure You are in the Know

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CMS Fraud Waste and Abuse 2016: Make Sure You are in the Know

The Centers for Medicare and Medicaid Services (CMS) continues to focus detection and enforcement efforts on Fraud, Waste and Abuse by taking aim in 2016 for a variety of CMS priorities. CMS continues to utilize data analytics and algorithms in “addressing the full spectrum of program integrity issues, in taking swift administrative actions, and in the performance of audits, investigations and payment oversight”.  Healthcare organizations must remain diligent in their efforts to prevent Fraud, Waste and Abuses through education and compliance oversight programs.

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Why Humana is Giving $77M to Various Physician Groups

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Why Humana is Giving $77M to Various Physician Groups

Humana will distribute $77.2 million in bonus payments to roughly 3,700 physician groups nationwide who were engaged in its Provider Quality Rewards Program in 2014. The goal is to increase the 59% of Humana individual Medicare Advantage members who have primary care physicians participating in value-based relationships, to 75% by the end of 2017.

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Pending CMS Reimbursement Cuts Devastates CareDx

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Pending CMS Reimbursement Cuts Devastates CareDx

CMS has been proposing changes in reimbursement for a number of established molecular diagnostic tests provided by CareDx. According to its CEO Peter Maag, the company is urging the CMS to keep the current reimbursement price for AlloMap, a heart transplant blood test, that is currently used by 110 of 130 transplant centers in the United States.

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As Doctors and Hospitals Pursue Federal Money, Care Coordination is on the Rise

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As Doctors and Hospitals Pursue Federal Money, Care Coordination is on the Rise

Care coordination is essential for chronic patients. It can help keep patients with chronic illnesses, such as diabetes and heart problems, out of the hospital. Several pilot projects, specifically medical homes, chronic care management and accountable care organizations, promoted by the federal Medicare program encourage care coordination.

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We are Trapped in Our Own Healthcare System

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We are Trapped in Our Own Healthcare System

Quality and access are real issues in the American healthcare system, but the problems people deal with on a daily basis are rarely captured or even considered when people talk about fixing problems in healthcare. One doctor spoke about all the problems he faces with having ulcerative colitis in the current healthcare system.

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