Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. Characteristics of Prior Authorization Policies for New Drugs in Medicare Part D. N Engl J Med.

Medicare 144

Medicare Medicare Medicaid Medicaid 144

Bill of Health

JULY 15, 2022

Potential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. Post-Marketing Requirements for Cancer Drugs Approved by the European Medicines Agency, 2004-2014. JAMA Netw Open. 2022 Jun 1;5(6):e2216183.

Public Health 205

Public Health Medicare Medicare Governance 205

Hall Render

JULY 1, 2022

the Supreme Court upheld CMS’s decision to include Medicare exhaust and secondary payor days in the Medicare Fraction of the Disproportionate Share Hospital (“DSH”) statute. The DSH statute instructs CMS to include in the Medicare Fraction’s denominator all patients “entitled to benefits” under Medicare Part A.

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Providers also need an NPI to enroll in Medicare.

Fraud 97

Fraud HIPAA Medicare Medicare 97

AIHC

NOVEMBER 29, 2023

Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. MA/HMO) is typically used by Health Maintenance Organizations and Medicare Advantage Organizations. healthcare system were exorbitant. Capitation (e.g.,

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

NOVEMBER 29, 2023

Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. MA/HMO) is typically used by Health Maintenance Organizations and Medicare Advantage Organizations. healthcare system were exorbitant. Capitation (e.g.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

JUNE 9, 2023

The Supreme Court unanimously ruled that it could not support “such a boundless interpretation” of the Identity Theft Penalty Enhancement Act of 2004. Under the letter of the law, small-scale fraud and large-scale fraud carry the same sentence for aggravated identity theft. The Supreme Court disagreed.

Fraud 97

Fraud Medicaid Medicaid Doctors 97