CMS finalized updates to its physician fee schedule for 2024, as well as finalized the rule for next year’s Outpatient Prospective Payment System (OPPS). Provider groups are displeased with the updated rules, arguing that both physicians and provider organizations need more monetary relief than what the agency is offering.
Enrollment in Medicare Advantage is increasing, but the program has been drawing scrutiny from the government. Can the program be saved? One expert believes Medicare Advantage is a failed experiment. Another thinks that while the program has its flaws, it shows tremendous potential.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Cigna recently agreed to pay $172 million to resolve allegations that it violated the False Claims Act. One expert said this is just a small part of the problem, while another called for more clarity from the government.
The average monthly plan premium for Medicare Advantage is expected to increase only slightly in 2024 from 2023, CMS said. About 73% of beneficiaries will see no increase at all.
Thirty states have been conducting Medicaid and CHIP automatic renewals incorrectly, leading to many individuals being wrongly removed from coverage. Because of this, nearly 500,000 children and other individuals will have their coverage reinstated.
CMS has fined two hospitals in September for alleged violations of its price transparency rule. This marks the third month in a row that the agency has issued fines against hospitals for price transparency noncompliance, following a yearslong period of light enforcement.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Only actual hospital prices, displayed as dollars and cents, not estimates, formulas, or algorithms, protect patients from outrageous bills and hold hospitals accountable for overcharges, errors, and fraud. Accepting CMS' or other substitutes instead of actual prices undermines broader efforts to make hospital price transparency a reality for American patients and healthcare consumers.
CMS released a proposed rule to establish staffing standards among the nation’s nursing homes. Reactions have been mixed — but mainly negative. Long-term care facilities say that they can neither find nor afford more workers. On the other hand, some lawmakers argue the proposed rule doesn’t do enough to protect care quality for patients. As for labor unions, they seem generally happy with the rule.
Some states may not be following federal requirements for the Medicaid renewal process, resulting in many individuals being wrongly removed from coverage, CMS said. Children may especially be affected.
For the sixth year in a row, the Medicare Shared Savings Program created overall savings, CMS announced. When compared to clinician groups of a similar size not participating in the program, participating ACOs performed better on quality measures, including measures for diabetes, breast cancer and colorectal cancer screenings, tobacco screenings and depression screenings.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
The role of the family caregiver is considered part of the cycle of life. But it can be time consuming and stressful, especially if caregivers have to balance their role with a job, raising children, and other aspects of family life. The topic will be one of many discussed at the HLTH event in Las Vegas from October 8-11.
CMS recently announced that it will change the administrative fee that providers and insurers must pay when initiating a reimbursement dispute under the No Surprises Act — the agency is lowering the fee from $350 to $50. This move came a week after the Texas Medical Association won a court case challenging HHS over its 600% price hike on the fee.
The average total monthly premium for Medicare Part D coverage is expected to be $55.50 in 2024, down from $56.49 in 2023, according to CMS.
About 36% of U.S. hospitals are in compliance with CMS' price transparency rule, up from 24.5% in February, according to a new report. This progress will remain slow unless CMS can do a better job of effectively enforcing its rule, the report declared.
KFF found that the 10 top-selling Part D drugs represented $47.7 billion of the $215.7 billion total gross Medicare Part D drug spending in 2021. Eliquis, a blood thinner by Bristol Myers Squibb, accounted for the most spending out of these 10 drugs at $12.6 billion.