Health Policy and Economics

Medicare Overpayment Demands and Risk

Medicare overpayment demands can expose weak controls, strain cash flow, and invite scrutiny. Providers need a disciplined response before recoupment begins....
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Also this Week

Recent Analysis

How Reimbursement Cuts Affect Margins in Post-Acute Care

Health Policy and Economics

How Reimbursement Cuts Affect Margins

Medicare post-acute care (PAC) reimbursement is increasingly driven by stricter federal spending controls, closer Medicare Advantage (MA) utilization oversight, and limited rate increases. Current policy priorities center on value-based accountability, shifts to lower-intensity care settings,…

9 min read

Health Policy and Economics

Update: Medicare Advantage Prior Authorization

A review of Medicare Advantage prior authorization starts with an operational reality: a clinically appropriate service can be delayed, redirected, or denied before the provider ever has an opportunity to deliver it. For hospitals, skilled…

8 min read
CMS Withholds $1B in Medicaid Payments From CA, MN

Policy and Politics - Federal

CMS Defer $1B in Medicaid Payments to CA, MN

The report that CMS is withholding $1B in Medicaid payments from California and Minnesota is not merely another Washington-versus-state-capital political skirmish. It is a reminder that Medicaid is financed through a conditional partnership, and federal…

9 min read
Fee for Service vs Value Based Care: What Changes

Health Policy and Economics

Fee for Service vs Value Based Care

A hospital can fill beds, a skilled nursing facility can maintain census, and a physician group can increase visits while the broader system still produces avoidable cost and uneven outcomes. That is the central tension…

9 min read
CMS Modernizes Nursing Home Oversight With Risk Surveys

Policy and Politics - Federal

CMS Changes SNF Surveys With New Risk Surveys

CMS is launching a streamlined review process for higher-performing nursing homes and making them easier for consumers to find on Medicare.gov. A new Quality, Safety, & Oversight memo outlines the risk-based survey process, which helps…

9 min read

Health Policy and Economics

Why Rural Health Transformation Matters

Rural providers are being asked to preserve access with urban-level expectations and far thinner margins. That is the core tension any rural health transformation program must confront. For hospitals, post-acute operators, clinics, and community-based organizations…

8 min read
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Reg

Healthcare executive, consultant, and author covering post-acute care, senior living, and the economics behind both - for 30+ years.

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