Black Tuesday Falls on a Friday for Nation’s Nursing Homes

If you think of CMS quality ratings as the Dow Jones index, then last Friday, February 20, was the equivalent of Black Tuesday, October 29, 1929, the day the stock market collapsed.  Why?  Because on February 20 quality rankings dropped for a whopping 63% of the nation’s nursing homes. Did care at …

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Ministry Motivation Costs Hospital $59 Million

Sometimes doing the right thing for the right reason can be costly.  Last week it cost nonprofit Via Christi Regional Medical Center $59 million. In 1995 two Wichita hospitals, St. Francis and St. Joseph, consolidated to create Via Christi.  For the two decades since then, Via Christi—as successor of St. …

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CMS Announces 20 Repairs to RAC Program

Ever face the choice between trading in your old car or paying for multiple repairs?  CMS faced that kind of choice with its Recovery Audit Contractor (RAC) program.  Under the RAC program, contract auditors audit hospitals and other providers.  Guess how they’re paid?  They get a percentage of all the money …

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Pain Clinic Sues CMS Over $25 Million Repayment Demand

Alabama Pain Center thought it knew all about pain, but nothing had prepared it for the bill it received when CMS decided to retroactively “reprice” certain compounded drugs:  $25 million. The clinic is fighting back.  On Dec. 29 it filed a federal lawsuit seeking a declaration that CMS’s action—and …

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Debate Intensifies Over Medicare Advantage Plans’ Removal of Providers

Which is more important in a Medicare Advantage plan:  the plan’s flexibility to change its provider list during the plan year, or the enrollees’ right to confidence that their providers won’t be removed from the plan after they sign up? That’s the issue at the heart of an ever-intensifying debate in …

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Hospitals and Health Insurers Prodded on Same-Sex and Transgender Issues

In separate actions yesterday, CMS and the New York State insurance regulatory authority took steps to (a) assure equal treatment of same-sex spouses by hospitals and (b) insurance coverage of medically necessary transgender treatment by health insurers. The CMS action took the form of a proposed rule making it …

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