Feb 27, 2019 | Ambulance, Ground
CMS recently announced a demo to test new payment models for emergency ambulance care and transport services. Under the Emergency, Triage, Treat and Transport (ET3) Model, CMS will pay participating providers treating Medicare FFS beneficiaries to treat them on scene or transport them to a location other than a hospital, such as an urgent care center, if appropriate. Click to read more.
Feb 21, 2019 | Medicare, Post-Acute Care
In this report, BRG expert Greg Russo, and attorney Katie Pawlitz, address the role of data analytics in fraud investigations in the healthcare industry, both proactively by providers and during the course of a government investigation. The role of sampling in False Claims Act investigations and litigation is also explored in-depth, including a review of case law regarding the legality of sampling for use in addressing liability and damages. Click here to access the paper in BRG Review, Winter 2018 (volume 7).
Feb 20, 2019 | Medicaid, Medicaid Managed Care
Early this month, the North Carolina Department of Health and Human Services (DHHS) announced the five managed care organizations that will receive a combined $6 billion in annual Medicaid contracts, for a period of five years, starting in November 2019. This brief highlights awards and next steps. The announcement follows a multi-year process that began in 2015 when the state legislature ordered the Medicaid program to transition to managed care, with supporters of the switch arguing that it would help contain costs while improving the health of beneficiaries. Click to read more.
Feb 12, 2019 | Legislation/ Budgets/ Macro, Medicaid
According to a report published by Politico last month, the Trump administration is currently drafting guidelines which would give states the ability to implement Medicaid block grants—fixed amounts of Federal Medicaid funding in exchange for flexibility in program design. This brief dives into the issue. Click to read more.
