Fierce Healthcare

OCTOBER 4, 2024

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) released Oct. | CMS is looking to shake up the risk adjustment model and wants the ability to suspend shady brokers from the insurance marketplace, the agency wrote among other updates in a new proposed rule.

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Fierce Healthcare

MAY 7, 2024

New legislation extends the pandemic provisions for two more years, through 2026. The offsets for the bill include pharmacy benefit manager reforms.

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Medicare Medicare 105

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.

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Medicare Medicare Prescription Drug Pricing Compliance 94

Fierce Healthcare

OCTOBER 10, 2024

Allowing Medicare to cover anti-obesity medications would drive up federal spending by about $35 billion on net between 2026 and 2034, CBO estimates.

Medicare 59

Medicare Medicare 59

Fierce Healthcare

JULY 14, 2023

The Center for Medicare and Medicaid Innovation (CMMI) has released a request for information to design a future episode-based payment model. | It is expected that a new episode-based payment model would be implemented no earlier than 2026, CMMI said.

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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. .

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HIT Consultant

APRIL 4, 2025

Deacon Healths model aligns with broader industry reforms such as the Transforming Episode Accountability Model (TEAM), set to launch on January 1, 2026. TEAM will impact over 700 hospitals across 188 core-based statistical areas (CBSAs) mandated by the Centers for Medicare & Medicaid Services (CMS).

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Medicaid Medicaid Health Outcomes Medicare 52

HIT Consultant

DECEMBER 26, 2022

With a projection for the market to reach USD $3.7bn in 2026, here I explore five drivers fueling this period of robust growth. Although volumes dipped in 2020, the strong recovery witnessed in 2021 is set to continue with volumes reaching >6bn by 2026. Radiologist shortage leading to improved compensation.

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Healthcare IT News - Telehealth

MARCH 25, 2024

The Centers for Medicare and Medicaid Services just released data on its Acute Hospital Care at Home initiative , which thus far has admitted 11,159 patients suffering from respiratory infections, heart failure and severe sepsis. This is largely driven by an aging population and increasing preferences for care in familiar surroundings.

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Hospitals Health Outcomes Medicaid Medicaid 195

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. Medicare Part D will have three (3) phases instead of four (4) – Deductible, Initial Coverage Phase and Catastrophic Phase. generics) in the catastrophic phase.

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Medicare Medicare Compliance FDA 52

Health Populi

FEBRUARY 14, 2018

Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. trillion in 2026 when healthcare spending will be $1 in every $5 in the American economy (approaching 20%).

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Health Insurance Medicare Medicare Medicaid 79

HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. LinkedIn – [link].

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Medicaid Medicaid Medicare Medicare 98

Innovaare Compliance

JUNE 27, 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 52

Medicare Medicare Compliance Prescription Drug Pricing 52

HIT Consultant

FEBRUARY 21, 2024

Don Rucker, MD – Chief Strategy Officer, 1upHealth CMS and Medicare are trying to change the dynamics of American healthcare. For the last 20 years, Medicare Fee for Service has been the hotspot of spending and value. Now fast forward to today and Medicare Advantage has more beneficiaries.

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Medicare Medicare Doctors Medicaid 52

Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”).

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Hospitals Medicare Medicare Medicaid 66

Innovaare Compliance

OCTOBER 31, 2023

Every October, with the release of CMS Medicare Advantage Star ratings, millions remember the famous Heraclitus quote (Greek philosopher): “Change is the only constant in life.” The post 2024 Medicare Advantage and Part D Star Ratings: Key Observations and Takeaways appeared first on Inovaare.

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Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

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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]

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Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026.

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Electronic Medical Records Doctors Governance Medicaid 122

Healthcare IT News - Telehealth

AUGUST 28, 2023

The Acute Hospital Care at Home waiver program from the Centers for Medicare & Medicaid Services has grown to 125 health systems and 289 hospitals in 37 states in less than three years. For those who don't know, please describe the Acute Hospital Care at Home waiver program from the Centers for Medicare & Medicaid Services.

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Hall Render

JANUARY 9, 2025

On November 26, 2024, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that revises the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program and Programs of All-Inclusive Care for the Elderly for the Contract Year 2026 (Proposed Rule).

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Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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Fraud Medicare Medicare Overpayments 72

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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US Department of Health and Human Services Medicare Medicare Medicaid 52

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

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Medicare Medicare Compliance Medicaid 52

Healthcare IT Today

FEBRUARY 20, 2023

By 2026, Oak Street Health will have over 300 centers, each of which has the potential to contribute $7 million of Oak Street Health Adjusted EBITDA at maturity, representing more than $2 billion of Oak Street Health embedded Adjusted EBITDA at that time. And we do it all with heart, each and every day. Follow @CVSHealth on social media.

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Medicare Medicare Nurses Health Outcomes 97

Healthcare IT Today

SEPTEMBER 17, 2023

The EHR Association called for greater flexibility in the data completeness threshold and additional criteria to enhance patient matching accuracy, while MGMA called for a positive update to the Medicare conversion factor amid high inflation. East Tennessee Health Information Network chose 4medica to manage duplicate patient records.

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Nurses HIPAA Medicare Medicare 95

C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026. Our initial takeaways are summarized below.

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Medicare Medicare Medicaid Medicaid 59

Hall Render

JULY 25, 2023

A new mandatory bundled payment model is likely on its way in 2026, and the Center for Medicare & Medicaid Innovation (“CMMI”) is seeking input on how to structure the model to work for existing population-based models, including accountable care organizations (“ACOs”). Comments must be submitted by August 17, 2023.

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Medicare Medicare Medicaid Medicaid 40

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024. CMS sees this as a 3.7%

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Nurses COVID-19 Vaccine COVID-19 Medicare 40

HIT Consultant

OCTOBER 4, 2024

Ineffective Interventions: The report also casts doubt on the effectiveness of current interventions: Value-Based Care: Trilliant Health projects that value-based care programs will actually increase Medicare spending by $9.4 billion by 2026.

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COVID-19 Health Outcomes Medicare Medicare 52

Medisys Compliance

APRIL 18, 2022

In October 2021, the Center for Medicare and Medicaid Innovation (CMMI) announced a goal of having every Medicare beneficiary and the majority of Medicaid beneficiaries covered by some type of alternative payment model (APM) by 2030. In order to do so, a clinician must be in a Medicare Advanced APM.

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Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

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Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies.

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Medical Billing Medical Billing Outsourcing ACA Medicare 52

Healthcare IT Today

JUNE 7, 2023

In the comments that we will submit to ONC on HTI-1, we’ll also be encouraging ONC and the Centers for Medicare and Medicaid Services (CMS) to work more closely together to address the misalignments that frequently occur between when ONC tells software developers to deploy new certified versions and when CMS requires providers to be using them.

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FDA Compliance Regulatory Compliance Medicaid 97

Health Populi

SEPTEMBER 27, 2023

healthcare spending, with curves moving up and to the right, and the Medicare Hospital Insurance Trust Fund moving into the opposite direction toward insolvency by 2033. For this discussion, I’ll pick six exhibits from the Report’s roughly 140 exhibits — starting with the big picture of the unsustainable nature of U.S.

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COVID-19 Medical Billing Health Care Access Hospitals 100

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

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Medicaid Medicaid Medicare Medicare 52

HIT Consultant

JUNE 7, 2023

billion (about $42 per person in the US) per year after paying for the cost of food with most savings occurring within Medicare and Medicaid. She has expertise in Medicaid, Medicare, Social Determinants of Health, and federal/state regulations and their application within payer/provider environments. Over a 10-year period, $185.1

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