Tag Archives: fee-for-service

What We’re Reading – CMS overpaid Medicare Advantage (MA) by as much as $5.1 billion, according to the Government Accountability Office (GAO)

A report issued by GAO the week of March 7, indicates that CMS overpaid the MA program run by private companies by between $3.2 and $5.1 billion for the years 2010-2012. The overpayments were the results of CMS inadequately adjusting … Read Full Post

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Medicare ACOs: Stroke of Genius or Mathematical Impossibility? (Part 1)

The big buzz these days is about ACOs.  In this series, we will discuss some of the features of Accountable Care Organizations and explore the overall question:  Are Medicare ACOs a stroke of genius or a mathematical impossibility?  This five-part … Read Full Post

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What We’re Reading – Study: Special Home-Visit Program Could Promote Prevention

A special Medicare program aimed at keeping patients with chronic diseases out of the hospital may help lower health care costs by focusing on prevention of expensive complications.  A study conducted by XLHealth and America’s Health Insurance Plans found that … Read Full Post

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How does provider reimbursement work?

There are two common methods of reimbursing physicians: Fee-for- service (FFS) and capitation. There are also two major code categories in use by most primary care physicians: ICD-9-CM codes and CPT-4 & HCPCS codes. ICD-9-CM codes (soon to be replaced … Read Full Post

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