Part B

The Challenge of Medicare Insolvency

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Medicare Insolvency Projections Explained

Medicare insolvency projections shape provider strategy, payment risk, and policy debate. Here’s what healthcare leaders should watch next.

Doc Payment Fix Bill in the Works?

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A bipartisan group of House representatives introduced a bill on Friday aimed at addressing and exceeding a pay cut for doctors that took effect at the beginning of this year. The legislation, known as the Medicare Patient Access and Practice Stabilization Act of 2025, seeks to mitigate the financial strain on physicians caused by the … Read more

Doc Payment Fix in the Works?

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Here’s an oldie but a goodie for today. The House Ways and Means Committee is reportedly considering a markup of legislation this month that would revamp Medicare’s physician payment system. This move could increase the likelihood of incorporating a “doc fix” into a lame duck legislative package. Historic readers and followers of Reg’s Blog will … Read more

Legislation Grab Bag

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Within the normal news cycle, legislation often gets ignored, especially in this hyper volatile election cycle we have begun. I’m expecting very little in terms of reform or new legislation on important healthcare issues to come forward, and, so far, I’m right. With near gridlock due to small opposing majorities in both houses of Congress, … Read more

CMS Offers Fix to Medicare Advantage Denials

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An issue that has been tied to AI (artificial intelligence) and specifically, to Medicare Advantage plans, involves coverage denials. I wrote about this in a post earlier this year at https://rhislop3.com/2023/05/01/medicare-advantage-part-d-final-rule/ Coverage denials have been a fairly hot topic around Medicare Advantage plans. The core of the issue is that Medicare Advantage plans are required … Read more

Medicare Advantage – Status Update

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Medicare Advantage plans or Medicare Part C and D plans continue to grow in popularity. I’ve written a number of posts on various Medicare Advantage topics, of late, coverage issues and denials, particularly for post-acute care stays. A recent post on that topic is here: https://wp.me/ptUlY-wI Medicare Advantage plans (Part C plans) include Parts A, … Read more

Medicare, Billing Audits and Self-Disclosure

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Over the last six months or so, I’ve written a number of articles on the issue of SNFs, therapy contracts/contractors, and recent fraud settlements. I’ve also given a few presentations on the same subject, covering how fraud occurs, the relationships between therapy contractors, SNFs and Medicare, and the keys to avoiding fraud. A reader question based … Read more

Doc Patch in the Works

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Yesterday, the Speaker of the House (John Boehner) announced that a compromise is forthcoming to alleviate, for one year, the pending 24% payment reduction to the Physician Fee Schedule arising out of the current SGR formula. Ten days or so ago I wrote a post regarding a House bill that repealed the SGR but contained … Read more

SNF Outlook: 2013

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As luck would have it, work interfered with my plans to have all of the industry outlooks for this year complete and published by February 1.  Good news: Ground work is done now I just need to get to the writing and editing on a consistent basis.  With any luck and a bit of fortitude, … Read more

Medicare Outpatient Therapy Rates: Part B

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I have a schedule or table if you prefer, of 2013 Part B Therapy Rates applicable to common SNF codes.  It is applicable as user selects, for the entire U.S.  As rates are only available on a “guesstimated” basis right now and somewhat subject to slight modifications, the version is not 100% guaranteed.  I do … Read more