Medicare

2024 review and successes

As 2025 gets under way, it might be a good time to highlight some of our 2024 success stories.

These will be somewhat generic explanations as nearly all of these are covered with Non-Disclosure Agreements.

- We provided cost analytics that along with clinical explanations enabled Medicare to make changes to certain payment policies. As the result, more patients potentially will have access to life-savings treatments.
- We worked with another company to help them better understand patient demographics and economics for a rare disease. This work helps paint a broader understanding of treatment options and disease progression. Not only did the research result in a poster for a major conference, the poster won an award for presentation.
- We helped another company verify and understand mortality and economic costs of certain types as gastrointestinal surgeries. This economics understanding should go a long ways toward helping patient outcomes as well as controlling hospital costs.
- We helped a number of early stage start-up companies better understand the economics of their new devices or treatments. We were able to assist them in better understanding their pathway to patient care and marketplace acceptance.

It’s a book few healthcare analysts see unless they are Medicare eligible. Each year, generally in late September or early October, Medicare publishes “Medicare & You” a handbook to help beneficiaries navigate their Medicare coverage.

Given the complexities, it’s a surprisingly well done publication with generally easy to understand, clear explanations. When the material becomes too involved, Medicare often includes pointers to where more information can be found. Continue reading “A best seller: Medicare & You”

About Medicare Cost Reports

There are often two widespread, often incorrect beliefs about Medicare Cost Reports.

First is the terminology. “Medicare” cost reporting makes it sound as if it only covers Medicare patients. This is not accurate. For most of the key worksheets — there are several dozen — the data generally covers services for all patients. Only fairly late in the cost report calculations that Medicare costs are determined.

Continue reading “About Medicare Cost Reports”

About CMS Form 1450…

Many are familiar with a medical form called the UB-04. It stands for “Universal Bill 2004” and is the name of a billing form used by hospitals and other facility providers. (Physicians typically use the HCFA 1500 form which is somewhat similar.)

What some don’t realize is that Medicare gives the UB-04 its own designation as CMS Form-1450. Few call it that because it serves many different providers and payers than just CMS. Continue reading “About CMS Form 1450…”

HCFA is gone, but the form lives

The HCFA moniker is a decades-old name that is no longer used except for the HCFA-1500 form. The name comes from the Health Care Financing Administration (HCFA) which was created in 1977 to combine under one administration the oversight of the Medicare program, the federal portion of the Medicaid program, and related quality assurance activities.

In July 2001, agency known as HCFA was renamed the Centers for Medicare and Medicaid Services or what today is abbreviated as CMS.

Nonetheless, the HCFA-1500 form name survived the 2001 renaming exercise and is still used today for physician and non-facility bills.