The Centers for Medicare & Medicaid Services (CMS) issued a revised memo Wednesday to strengthen the Special Focus Facility ...

The proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses.

Policymakers are exploring reforms to address shortcomings of risk adjustment that inflate Medicare Advantage payments and ...

On a day when health insurers were reeling from the Trump administration proposing minimal increases to Medicare Advantage (MA) rates next year and a tightening of risk adjustment rules, a top CMS ...

While providers aren’t required to follow OIG recommendations, a compliance program based on their guidance can spare ...

Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models. Objectives: To ...

The threat of virtually no payment rate increases next year for Medicare Advantage plans sent managed care organizations, and ...

Medicare Advantage organizations may be improperly using health risk assessments to increase risk-adjusted reimbursement, according to a report HHS’ Office of Inspector General issued in September.

CMS released proposals to update cardiovascular disease risk assessment and risk management services. The organization proposed coding and payment for an atherosclerotic cardiovascular disease risk ...

Medicare covers fall risk assessments during routine preventive visits for beneficiaries enrolled in Part B. If you have a history of recent falls or issues with walking and balance, you may be a ...