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APTA has spoken often about the longstanding myth that Medicare does not cover services to maintain or manage a beneficiary's current condition when no functional improvement is possible. The Jimmo [...]

Background. The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. A systematic approach to determine a patient's functional limitations [...]

SECOND SIGHT Medical Products Inc. announced that the Centers for Medicare & Medicaid Services (CMS) has finalized its Medicare hospital outpatient payment rate of $152,500 for the Argus II Retinal [...]

EYEPOINT Pharmaceuticals announced the Centers for Medicare and Medicaid Services (CMS) has assigned a specific/permanent reimbursement J-code for dexamethasone intraocular suspension 9% (DEXYCU), the first and only FDA-approved, single-dose, sustained-release, [...]

-- The CMS has kept its promise to release Medicare Advantage data to researchers looking to analyze care trends for seniors. It's the first time the agency has done so. [...]

-- The average salary for primary-care and specialty doctors in the U.S.rose this year, although women and minority physicians still earn significantly less than white and male doctors, a new [...]

A simple change to the Medicare and Medicaid outpatient prescription drug billing systems could improve patient safety and the systems' long-term fiscal stability. Including diagnosis codes on prescription drug claims [...]

In today's genomic era, personalized medicine offers new options to improve healthcare delivery, especially for vulnerable populations such as the elderly. To advance this agenda, the Centers for Medicare and [...]

Review the work that engineers and clinicians put into creating an amendment to the standard for relative humidity in the operating room and other spaces. The goal was to see [...]

Healthcare organizations continually strive to provide high-quality care. With growing accountability for providing and demonstrating best practice care, organizations look for new ways to achieve best practice clinical and financial [...]

The CMS clarified what it means to be a hospital: 'Hospitals must have at least two inpatients at the time of the survey in order for surveyors to conduct the [...]

Data reporting, at its core, is about telling a story. Individuals use data to understand what happens within the walls of your facility and what becomes of the patients who [...]

INTRODUCTION Measuring quality of care is the essential foundation for improving care, and improving the care provided to Medicare and Medicaid beneficiaries is the central goal of HCFA's Health Care [...], The Health Care Financing Administation's (HCFA) approach to measuring quality of care uses an accepted definition of quality, explicit domains of measurement, and a formal validation procedure that includes face validity, construct validity, reliability, clinical validation, and tests for usefulness. The indicators of quality for Medicare and Medicaid patients span the range of service types, medical conditions, and payment systems and rest on a variety of data systems. Some have already been incorporated into operational systems while others are scheduled for incorporation over the next 3 years.

INTRODUCTION The massive shift to managed care in many State Medicaid programs heightens the focus on identifying approaches that can be used effectively in promoting and overseeing quality in plans [...], The massive shift to managed care in many State Medicaid programs heightens the importance of identifying effective approaches to promote and oversee quality in plans serving Medicaid enrollees. This article reviews operational issues and lessons from the ongoing evaluation of a three-state demonstration of the Health Care Financing Administration's (HCFA) Quality Assurance Reform Initiative QARI) for Medicaid managed care. The QARI experience to date shows the potential utility of the system while drawing attention to the challenges involved in translating theory to practice. These challenges include data limitations and staffing constraints, diverse levels of sophistication among States and health plans, and the practical limitations of using quality indicators for a population that is often enrolled only on a discontinuous basis. To overcome these challenges, we suggest using realistically long timeframes for system implementation, with intermediate short-term strategies that could treat States and managed-care plans differently depending on their stage of development.

INTRODUCTION As part of its Strategic Plan and as the Nation's largest managed-care purchaser, HCFA is working to promote improved quality of care, responsiveness, and outcomes for Medicare and Medicaid [...], As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) conduct of health maintenance organization (HMO) quality review, pilot testing a new HMO performance-measurement system, establishing criteria for Medicaid HMO quality-assurance (QA) programs, adapting employers' HMO performance reporting systems to the needs of medicare and Medicaid, and participation in a new alliance between public and private sector managed-care purchasers to promote quality improvement and accountability for health plans.

INTRODUCTION HCQIP's mission is to enhance the quality, effectiveness, and efficiency of services provided to HCFA beneficiaries. The basic premise of the HCQIP is that beneficiaries will benefit most from [...], The Health Care Financing Administration (HCFA) has embarked on a new program to ensure the quality of care provided to Medicare and Medicaid, beneficiaries. The approach, entitled the Health Care Quality Improvement Program (HCQIP), focuses on Improving the outcomes of care, measuring improvement, and surveying for patient satisfaction. HCQIP, still in its infancy, is undertaken in collaboration with the providers of care. This article describes HCQIP.

Providers and purchasers interviewed during HFMA's Value Project expressed concern over the proliferation of value measures. Without thoughtful measurement selection, both groups believe the potential exists to increase administrative expense [...]

The biggest changes in coding for ObGyn procedures are urodynamics study codes. The American Medical Association (AMA) has 1) created three new codes that represent test bundles and, in the [...]

Welcome to the sticky world of HCFA's form 109. Prepare it with clinically strict accuracy. Believe it or not, the future of your laboratory depends on how well you fill [...]

The joke currently making the rounds goes like this: The nice d thing about healthcare computing standards is that there are so many to choose from! There's more than a [...]

Payment for more telemedicine services could be in store for physicians and other health providers if new proposals in the latest fee schedule from the Centers for Medicare & Medicaid [...]

Proper claims payments may seem like a simple numbers game, but the Centers for Medicare and Medicaid Services (CMS) fee for service (FFS) program continues to battle improper payments, whether [...]

APTA's Physical Therapy Outcomes Registry (Registry) has been approved again by the US Centers for Medicare and Medicaid Services (CMS) as a qualified clinical data registry (QCDR). The designation for [...]

Rates for the 2010 Medicare prospective payment system (PPS) for home health agencies have been released. The Centers for Medicare and Medicaid Services (CMS) issued the rates for the PPS, [...]

The CMS will allow Det Norske Veritas Healthcare to accredit U.S. hospitals, a move that puts the company in a small group of deeming organizations and could bring an increased [...]

Lawmakers expressed alarm over the results of a federal investigation that found that marketing materials for Medicare prescription drug plans generally fail to meet CMS guidelines. A report issued by [...]

Medicare covers skilled therapy services that a patient needs to maintain function or to prevent or slow decline, emphasizes a new Centers for Medicare and Medicaid Services (CMS) website. Publicizing [...]

The federal government must do more to educate Medicare decision-makers that improvement in function is not a requirement for skilled-care services, including speech-language and swallowing treatment, according to a federal [...]

Pharmacists and potential plan sponsors finally got the ground rules from Uncle Sam on how they can market prescription drug plans (PDPs) to Medicare beneficiaries, who can begin enrolling in [...]

Twelve Blue Cross and Blue Shield plans sued nine surgery centers in Southern California, seven management companies and 34 individuals for allegedly paying patients to undergo needless and sometimes dangerous [...]

Medicare's Outpatient Prospective Payment System (OPPS) took a hit recently. A report from the Government Accountability Office detailed problems in the way OPPS rates are set. GAO recommended that the [...]