Fierce Healthcare

NOVEMBER 4, 2024

Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)

Medicare 127

Medicare Medicare Medicaid Medicaid 127

Healthcare IT News - Telehealth

APRIL 22, 2024

Medicare was the first to cover RPM. Currently, it also is covered in some form by about 32 state Medicaid programs. It is also worth noting that Medicare is not necessarily required to update its coding rules to reflect AMA's CPT code rules. These have been the four most common general RPM codes for a few years now.

Medicare 180

Medicare Medicare Medicaid Medicaid 180

Fierce Healthcare

DECEMBER 17, 2024

The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025. | The Value-Based Insurance Design model for Medicare Advantage plans will be terminated at the end of next year.

Medicare 90

Medicare Medicare Medicaid Medicaid 90

Fierce Healthcare

NOVEMBER 25, 2024

UnitedHealthcare successfully won its lawsuit over the Centers for Medicare and Medicaid Services, a federal judge determined Nov. UnitedHealthcare will get to claim victory over CMS for its star ratings lawsuit win.

Medicaid 119

Medicaid Medicaid Medicare Medicare 119

Fierce Healthcare

OCTOBER 21, 2024

Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star | Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star ratings results.

Medicaid 116

Medicaid Medicaid Medicare Medicare 116

Fierce Healthcare

JULY 10, 2024

A proposed rule outlining the Centers for Medicare & Medicaid Services’ (CMS’) intended Medicare payment rates and policy updates for outpatient and ambulatory surgical centers (ASCs) in the co | The administration's CY 2025 OPPS and ASC Payment Systems proposed rule looks to improve obstetrical services, quality reporting and care access. (..)

Payment Systems 124

Payment Systems Medicare Medicare Medicaid 124

Fierce Healthcare

JULY 11, 2024

The Centers for Medicare & Medicaid Services' (CMS') proposed calendar year 2025 physician fee schedule rule, out Wednesday, proposed an assortment of new payments and coverage for digital heal | CMS' proposed changes to digital health payment for physicians includes new codes for mental health-related digital therapeutics, an assortment (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

ACA 110

ACA Medicaid Medicaid Medicare 110

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. The coverage gap will be eliminated in 2025, and manufacturers’ discounts will begin in ICL.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

APRIL 6, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1]. The cost to Medicare Part D would be $26.8

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

HIT Consultant

JULY 15, 2024

– The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments under the Physician Fee Schedule (PFS) for services furnished and other Medicare Part B issues on or after January 1, 2025.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. million per year starting in 2025 for PY 2018 from extrapolated recoveries.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Healthcare IT News - Telehealth

AUGUST 29, 2024

The American Telemedicine Association and ATA Action in a letter to the Centers for Medicare and Medicaid Services seeks to preserve pandemic-era Medicare telehealth flexibilities that it says are responsible for improving access to healthcare across the U.S. Permit access virtual cardiac and pulmonary rehabilitation services.

Medicare 122

Medicare Medicare Medicaid Medicaid 122

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Innovaare Compliance

JUNE 30, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Notable changes related to Part D Re-design and regulations in the final rule are highlighted below: Part D Coverage Gap is removed in CY 2025, as all references should be (e.g., Section 2.1 and Section 3.2,

Medicare 52

Medicare Medicare Compliance Medicaid 52

Innovaare Compliance

JUNE 28, 2024

The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach to prescription drug coverage. Understanding the Medicare Prescription Payment Plan M3P introduces a novel approach to managing prescription drug costs for Medicare beneficiaries.

Medicare 94

Medicare Medicare Prescription Drug Pricing Compliance 94

Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ). CMS does not anticipate that these new prices will result in lower pharmacy reimbursements. .

Medicare 98

Medicare Medicare Medicaid Medicaid 98

HIT Consultant

JULY 18, 2024

– In accordance with the AMA semi-annual early release schedule, the new codes will be effective January 1st, 2025 and published in the 2025 CPT Code book. CPT Codes: CPT codes are essential for healthcare reimbursement, used by government payers such as Medicare and Medicaid, as well as commercial insurance companies.

FDA 114

FDA Medicaid Medicaid Medicare 114

Bill of Health

OCTOBER 17, 2024

This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets. 2025) research interests are focused on the intersection of health and the law. Rebekah Ninan’s (J.D.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1]. The cost to Medicare Part D would be $26.8

Medicare 59

Medicare Medicare COVID-19 Medicaid 59

Healthcare IT News - Telehealth

APRIL 9, 2019

Centers for Medicare and Medicaid Services Administrator Seema Verma has called for expansion of reimbursement for remote care, with CMS seeking to "make sure home health agencies can leverage innovation to provide state-of-the-art care ," she said. " Twitter: @MikeMiliardHITN.

Hospitals 166

Hospitals Medicaid Medicaid Medicare 166

Healthcare IT News - Telehealth

SEPTEMBER 15, 2021

Research firm Frost & Sullivan forecasts a sevenfold growth in telehealth by 2025 – a five-year compound annual growth rate of 38%. The Centers for Medicare and Medicaid Services (CMS) began to allow for reimbursement for videoconferencing between healthcare provider and patient.

Telemedicine 192

Telemedicine COVID-19 Medicare Medicare 192

HIT Consultant

DECEMBER 11, 2024

Food as Medicine: This trend has emerged from its niche, driven by increased funding and partnerships, particularly within Medicare Advantage and Medicaid programs. Looking Ahead to 2025 The digital health landscape is constantly evolving.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1]. The cost to Medicare Part D would be $26.8

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Innovaare Compliance

JUNE 17, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Notable changes related to Part D Re-design and regulations in the final rule are highlighted below: Part D Coverage Gap is removed in CY 2025, as all references should be (e.g., Section 2.1 and Section 3.2,

Medicare 40

Medicare Medicare Compliance Medicaid 40

Hall Render

SEPTEMBER 10, 2024

On July 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year 2025 Medicare Physician Fee Schedule (“MPFS”) proposed rule (“Proposed Rule”), to implement certain payment updates effective January 1, 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Jane Sarashon

JULY 18, 2024

Following the BLS report on the CPI for June 2024, PwC published their new annual report from PwC titled Behind the Numbers 2025 tells us that commercial health care spending is expected to grow some 8.0% (Motor vehicle insurance costs grew a whopping 19.5% in the report, FYI). for Group plans and 7.5% and 7.0%, respectively.

Doctors 59

Doctors Prescription Drug Pricing Hospitals Health Insurance 59

Provider Trust

NOVEMBER 20, 2024

The National Committee for Quality Assurance (NCQA) has released updated standards for credentialing processes among payers for 2025. Though these guidelines take effect on July 1, 2025, payers must act now to ensure they can ramp up their credentialing processes appropriately.

Licensing 52

Licensing Compliance Medicaid Medicaid 52

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. The application process for the MSSP is split into two phases.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Hall Render

AUGUST 27, 2024

The Centers for Medicare & Medicaid Services (“CMS”) will publish the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) in the Federal Register on August 28 with an effective date of October 1, 2024. In FY 2025, acute care hospitals are estimated to experience a $3.2

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Healthcare Law Blog

FEBRUARY 22, 2023

The Rebate Programs are administered as part of the prescription drug affordability provisions of the Inflation Reduction Act (the “IRA”), which is aimed at “lower[ing] out-of-pocket drug costs for people with Medicare and improv[ing] the sustainability of the Medicare program for current and future generations.” [1]

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Center for Health Insurance Reform

MAY 15, 2024

The Centers for Medicare & Medicaid Services have recently finalized rules and standards governing health plans and Marketplaces under the Affordable Care Act.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

FEBRUARY 15, 2022

billion by 2025. Given CMS’ recent decision to double the weight of experience-based quality measures used to calculate Medicare Advantage Star Ratings, harnessing the power of these two types of analytics applications together could become a key determinant of success in 2022 and beyond. Medicaid, Medicare Advantage).

Medicare 98

Medicare Medicare Medicaid Medicaid 98