Healthcare Dive

AUGUST 2, 2024

Hospitals still weren’t happy with the final rule despite the bump from the CMS’ proposed rates, citing cuts to long-term and disproportionate share facilities.

Medicare 301

Medicare Medicare Hospitals 301

Healthcare Dive

OCTOBER 3, 2024

Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed Wednesday. The downgrade could wipe out Humana’s profits in 2026.

Medicare 294

Medicare Medicare 294

Fierce Healthcare

OCTOBER 30, 2024

Physicians and other healthcare practitioners may get a pay boost in 2025 through a bipartisan bill introduced in Congress on Tuesday. | The bill would increase the 2025 Physician Fee Schedule conversion factor by 4.73%, which would wipe out the expected 2.8% inflationary payment increase for 2025.

Medicare 98

Medicare Medicare 98

Healthcare Dive

NOVEMBER 4, 2024

The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.

Medicare 242

Medicare Medicare 242

Healthcare Dive

FEBRUARY 10, 2023

The CMS has laid out how it plans to implement a key provision of the Inflation Reduction Act requiring drugmakers to pay rebates on price hikes in Medicare that are greater than inflation.

Medicare 269

Medicare Medicare 269

Healthcare Dive

OCTOBER 23, 2024

Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.

Medicare 268

Medicare Medicare 268

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

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Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment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

JULY 31, 2024

The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.

Medicare 337

Medicare Medicare 337

Healthcare Dive

JULY 11, 2024

Regulators said Medicare’s budget neutrality requirement is to blame for the reduction, which was quickly decried by provider groups. However, it’s likely Congress will step in to mitigate the drop.

Medicare 298

Medicare Medicare 298

Healthcare Dive

JUNE 6, 2024

Hundreds of thousands of seniors could switch plans during next year’s open enrollment, depending on how drastically the MA market giants slash benefits in an attempt to improve profits.

Medicare 334

Medicare Medicare 334

Fierce Healthcare

MARCH 11, 2024

trillion budget for fiscal year 2025 on Monday, which continued upon and expanded key health items from previous years. Drug price negotiations and Medicare solvency were just two areas HHS officials hit upon while unveiling President Biden's 2025 fiscal year proposed budget. President Biden unveiled a proposed $7.3

Medicare 135

Medicare Medicare 135

Mobi Health News

JULY 12, 2024

The proposed 2025 physician fee schedule from the Centers for Medicare & Medicaid Services includes payment and coding for digital health tools for behavioral health.

Medicaid 117

Medicaid Medicaid Medicare Medicare 117

Med Law Blog

JULY 15, 2024

CMS proposed several telehealth changes in the 2025 Medicare Physician Fee Schedule Proposed Rule, issued July 10, 2024. CMS has also proposed that “immediate availability” for purposes of direct supervision for all other services will include real-time audio and visual interactive communications only through December 31, 2025.

Medicare 40

Medicare Medicare Telemedicine 40

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

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. PDT on June 3, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Fierce Healthcare

AUGUST 7, 2024

Centene is exiting six states through its WellCare Medicare Advantage subsidiary next year, investment bank Stephens has revealed. WellCare is leaving six states next year, impacting more than 37,000 Centene members across the country.

Medicare 122

Medicare Medicare 122

Healthcare Dive

FEBRUARY 1, 2024

The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.

Medicare 261

Medicare Medicare 261

Fierce Healthcare

JUNE 3, 2024

Blue Cross and Blue Shield of Kansas City is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. Blue Cross and Blue Shield of Kansas City is opting out of the Medicare Advantage market.

Medicare 124

Medicare Medicare 124

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

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

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

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

FEBRUARY 5, 2024

Humana reaffirmed its guidance in the face of likely cuts in Medicare Advantage payment rates for 2025, despite saying the proposed decrease was higher than it expected.

Medicare 97

Medicare Medicare 97

Med Law Blog

NOVEMBER 11, 2024

The final Medicare Physician Fee Schedule was issued on November 1 st for calendar year 2025. Attached is a link to both the Press Release describing all of the Medicare changes and the link to the entire Final Rule. The Medicare Conversion Factor for the Physician Fee Schedule was decreased from $33.29

Medicare 40

Medicare Medicare 40

HealthIT Answers

AUGUST 8, 2024

By James Pelletier - CMS has introduced significant proposals that impact the Medicare Shared Savings Program and the transition from MIPS to MVPs for 2025. The post CMS Proposals for Healthcare Quality Reporting in 2025 and Beyond appeared first on Health IT Answers.

Medicare 59

Medicare Medicare 59

Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. The transformational changes in 2025 are highlighted below. CGDP will be replaced with a new Manufacturer Discount Program (MDP) in 2025.

Medicare 52

Medicare Medicare Compliance FDA 52

HealthIT Answers

APRIL 23, 2024

On April 10, 2024, CMS issued the fiscal year 2025 Medicare hospital inpatient prospective payment system and long-term care hospital prospective payment system proposed rule. The proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2025.

Hospitals 59

Hospitals Payment Systems Medicare Medicare 59

HIT Consultant

OCTOBER 22, 2024

What You Should Know: – Essence Healthcare , a provider of Medicare Advantage (MA) plans forms a new partnership with ŌURA , the maker of the Oura Ring. “For two decades, Essence has been at the forefront of innovation, dedicated to improving the lives of seniors and Medicare beneficiaries. ”

Medicare 98

Medicare Medicare 98

Fierce Healthcare

JANUARY 31, 2024

Cigna will sell off its Medicare business to Health Care Service Corporation in a deal valued at $3.7 HCSC will acquire Cigna's Medicare Advantage, Part D, supplemental benefits and CareAllies businesses, and the parties expect the deal to close in the first quarter of 2025. billion, the company announced Wednesday.

Medicare 124

Medicare Medicare 124

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 115

Medicaid Medicaid Medicare Medicare 115

Fierce Healthcare

OCTOBER 2, 2024

Humana's stock took a tumble early on Wednesday after it revealed in a filing with the Securities and Exchange Commission that its Medicare Advantage star ratings had declined significantly.

Medicare 116

Medicare Medicare 116

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

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 for a total increase of 2.9%.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Fierce Healthcare

NOVEMBER 3, 2021

Part D, Medicare Advantage drug plans must install cost-sharing cap by 2025 in new drug price bill. Wed, 11/03/2021 - 17:25.

Medicare 116

Medicare Medicare 116

Healthcare IT News - Telehealth

APRIL 22, 2024

Medicare was the first to cover RPM. If the AMA approves the changes under consideration, and Medicare follows suit, which it usually does, then providers who make modifications and expand their RPM programs to fit the new codes will gain the most benefits for their patients and their clinics. However, the federal agency often does so.

Medicare 170

Medicare Medicare Medicaid Medicaid 170