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CMS Issues Long-Awaited Medicare Advantage RADV Final Rule

Healthcare Law Blog

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. 3d 1, 18 n.19

Medicare 105
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CMS Issues Final Rule for DSH Medicare Advantage Days Policy

Hall Render

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

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District Court Elucidates the Meaning of “to Induce” Under the Federal Health Care Program Anti-Kickback Statute

Healthcare Law Blog

Department of Health and Human Services, Office of the Inspector General (“OIG”) concerning pharmaceutical manufacturers’ offers of cost-sharing subsidies to Medicare Part D (“Part D”) beneficiaries. The government, through Medicare, would foot the rest of the over-$111,000 bill for the year. [3] PCPA also argued that OIG Ad.

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Integrated EHR enables shift to virtual post-discharge follow-up

Healthcare IT News - Telehealth

The research team studied nearly 250,000 hospital discharges in patients with diabetes from 2005 to 2011. Although the study tracked patients from 2005 to 2011, before the current telehealth boom , it offers yet another piece of evidence for why virtual care is likely to remain a staple in healthcare even after the pandemic.

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Lean Digital: How Apps and Services Can Help Control Weight

Healthcare IT Today

A Congressional bill would promote behavioral therapy for obesity and extend Medicare coverage for drugs treating obesity. An important turning point was a 2005 study in JAMA published by a team led by Katherine Flegal of the Centers for Disease Control.

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Pharmaceutical Manufacturers Ask EDVa to Allow Cost-Sharing Under the AKS

Healthcare Law Blog

22-19 (the “Advisory Opinion”), which declared that a charitable organization funded by manufacturers would violate the AKS if it offered certain cost-sharing subsidies under Medicare Part D (“Part D”), even if the organization was independently run and patients had equal access to discounts for 90% of drugs on the market. and $500.39. [4].

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Resolving Commons Doubts while Billing 64625

Medisys Compliance

Is CPT 64625 Covered by Medicare? CPT code 64625 is covered by Medicare. However, it is important to note that Medicare coverage and reimbursement rates may vary depending on the specific circumstances of the procedure, such as the location where the procedure is performed and the patient’s individual coverage plan.