CMS recently revealed its proposals to raise reimbursement rates for hospital outpatient departments and cut payments for physicians. Next year, the agency is planning to decrease physicians’ pay by 1.25% and increase outpatient payment rates by 2.8%. Provider groups are unhappy with the news — AMA President Dr. Jesse Ehrenfeld said the new physician fee schedule will be “almost biblical in its impact.”
CMS recently proposed a $9 billion lump sum payment to remedy illegal payment cuts for 340B drugs from 2018 to 2022. In general, hospital groups have reacted positively to the fact that 340B providers will receive lump sum payments but have expressed concern about CMS’ methods for maintaining budget neutrality with this plan.
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.
The Making Care Primary Model will be tested by the Center for Medicare and Medicaid Innovation from July 1, 2024, to December 31, 2034, in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington.
Medicare could have saved $128 million if the Centers for Medicare and Medicaid Services had the correct controls in place to avoid duplicate payments with the Veterans Health Administration, an audit by the Office of Inspector General found.
CMS recently fined two hospitals for alleged violations of its price transparency rule. These fines are only the third and fourth penalties issued by the agency since the rule took effect on January 1, 2021. These fines may become more common — CMS also announced that it is updating its enforcement process for the rule.
A shift from fee-for-service payment models to value-based models is not an effective way to address the severe financial pressures that safety net hospitals are facing, experts argued at the HIMSS conference in Chicago. One called for a paradigmatic shift “away from cost savings and toward understanding where investments are needed.”
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.
A similar bill appeared last year but did not progress. Given the potential costs of reimbursing prescription digital therapeutics, Congress could be skeptical. Still, with growing attention on mental health, advocates are optimistic.
During a panel at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum, three executives were asked what gives them comfort about the return to Medicaid redeterminations, as well as what worries them. One CMS official said she's pleased that states are ramping up communication efforts for Medicaid enrollees, but is concerned about the "insurmountable task" ahead.
Conducted by researchers at the University of Colorado medical school, the new report is the latest to gauge the extent of a costly problem that federal regulators are working to solve: Information about doctors varies from provider directory to provider directory.
At the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held last week, two healthcare leaders from the Centers for Medicare and Medicaid Services (CMS) and CVS Health stressed that reducing maternal health disparities is a top priority, with several strategies at play. For CMS, the focus is on encouraging states to extend Medicaid postpartum coverage, while CVS Health is working to leverage doulas in their care delivery.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
CMS recently established a unique code for AppliedVR’s flagship product, marking the first time a digital therapeutic or immersive therapeutic has ever been placed in an existing benefit category. The eight-week program is a physician-prescribed solution that allows patients to manage their chronic lower back pain without opioids from the comfort of their own home.
CMS should honor its commitment to Medicare beneficiaries, especially those who began home respiratory therapy under the PHE, without requiring them to "restart" the documentation process. Requiring requalification would also be a nightmare for physicians who are already overwhelmed with patient demands.
CMS put out a request for information in October about a CMS-led national provider directory that would allow patients to find and compare providers based on preferences like language and location. Alexandra Mugge, director and deputy chief health informatics officer of the Health Informatics and Interoperability Group at CMS, said there is stakeholder support for the national directory — if it's executed correctly.
Companies who raised drug prices higher than the rate of inflation must rebate the difference to Medicare, according to a provision of the Inflation Reduction Act. The highest-profile product on the list might be AbbVie’s blockbuster immunology drug Humira.
During an interview at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held Tuesday in Washington, D.C., CMS Administrator Chiquita Brooks-LaSure discussed CMS' key focus areas for 2023. This includes the end of the public health emergency, health equity and prescription drug costs.