Electronic Health Reporter

NOVEMBER 28, 2018

As widely reported, based on exit polls, healthcare—not the economy—was the top issue on voters’ minds in the 2018 midterm elections. The article The Political Plausibility of Medicare for All appeared first on electronichealthreporter.com.

Medicare 89

Medicare Medicare 89

Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. The total amount of the penalties is determined by how much each hospital bills Medicare.

Medicare 123

Medicare Medicare Hospitals COVID-19 123

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.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

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.

Medicare 144

Medicare Medicare Medicaid Medicaid 144

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 52

HIT Consultant

SEPTEMBER 1, 2021

– The Bold platform is one of five interventions in the Ochsner Connected Stability pilot fall prevention and monitoring programs focused on helping Medicare Advantage members who are at the highest risk for falls. For non-fatal falls alone, $29 billion was paid out by Medicare in 2018 for treatment and care.

Medicare 52

Medicare Medicare Health Outcomes 52

Health Populi

JUNE 5, 2022

In 2006 the Medicare Part D program was implemented, covering older Americans for prescription drugs for the first time. Medicare further drove expansion of generic drug utilization, with co-pays for generics lower for Medicare enrollees than branded drugs. While these four actions to lower drug costs garner over 80% of U.S.

Overpayments 149

Overpayments Overpayment Medicare Medicare 149

HIT Consultant

SEPTEMBER 14, 2023

What You Should Know: – Out-of-network ground ambulance rides accounted for a larger percentage of ground ambulance claim lines 1 than in-network rides from 2018 to 2022. of all ground ambulance claim lines in 2018 compared to 59.4% of all ground ambulance claim lines in 2018 compared to 59.4% percent in 2018 to 30.6

Hospitals 98

Hospitals Medicare Medicare 98

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. percent in 2018.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

The Health Law Firm

OCTOBER 31, 2019

billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice medicine. The vast fraud scheme totaled $2.1 This appears to be a new national record.

Fraud 40

Fraud Medicare Medicare Doctors 40

Bill of Health

JULY 15, 2022

Cost Per Event Averted in Cancer Trials in the Adjuvant Setting From 2018 to 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. JAMA Netw Open. 2022 Jun 1;5(6):e2216058. JAMA Netw Open.

Public Health 205

Public Health Medicare Medicare Governance 205

The Health Law Firm

SEPTEMBER 24, 2018

Board Certified by The Florida Bar in Health Law On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. Indest III, J.D., Section 15.5.3 Section 15.5.3 New Language Basics.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

OCTOBER 3, 2019

billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice. The vast fraud scheme totaled $2.1 Fraudulent Orders for Genetic Testing.

Fraud 40

Fraud Doctors Medicare Medicare 40

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 52

The Health Law Firm

NOVEMBER 28, 2018

Board Certified by The Florida Bar in Health Law On November 2, 2018, a federal judge in Washington, D.C. said the US Department of Health and Human Services (HHS) has until the end of 2022 to completely clear out its backlog of thousands of Medicare billing appeals. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Hospitals 40

The Health Law Firm

AUGUST 10, 2018

Board Certified by The Florida Bar in Health Law On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment policies, payment rates, and quality provisions for services rendered under the Medicare Physician Fee Schedule (PFS). Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

JANUARY 27, 2023

UpStream has expanded rapidly since it’s 2018 launch, and now supports more than 1,000 primary care physicians and 180,000 Medicare patients in three states.

Medicare 52

Medicare Medicare 52

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

Medicare 59

Medicare Medicare COVID-19 Hospitals 59

HealthStream

DECEMBER 19, 2019

Leaders are looking to optimize software solutions which provide methods to improve efficient communication and required payer ongoing verifications, as well as integration with the Council for Accountable Quality Healthcare (CAQH), State Medicaid, and Medicare enrollment.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Innovaare Compliance

JUNE 21, 2023

The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). Part B drugs have had the fastest spending growth for drugs for Medicare. percent annually.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

HIT Consultant

NOVEMBER 2, 2023

This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

Medicare 52

Medicare Medicare COVID-19 Hospitals 52

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare Law Blog

NOVEMBER 1, 2022

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). See 42 U.S.C.

Medicare 52

Medicare Medicare COVID-19 Public Health 52

Healthcare It News

JUNE 13, 2023

Uber Health launched its HIPAA-enabled API and dashboard in 2018 to offer logistics services to population health management programs. The company says that 3,000 healthcare organizations are already using Uber Health for transportation to primary care appointments and accessing critical prescriptions.

Medicaid 183

Medicaid Medicaid HIPAA Hospitals 183

Bill of Health

MAY 19, 2022

from 2018-2019. Therapeutic Value Assessments of Novel Medicines in the US and Europe, 2018-2019. A full posting of abstracts/summaries of these articles may be found on our? Aboy M, Liddell K, Jordan M, Crespo C, Liddicoat J. European patent protection for medical uses of known products and drug repurposing. JAMA Oncol.

Health Insurance 205

Health Insurance Hospitals FDA Medicaid 205

Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. two whistleblowers were the doctor’s former?medical

Fraud 59

Fraud Doctors Elder Abuse Medicare 59

CMS.gov

OCTOBER 2, 2018

Modernizing Medicare to Take Advantage of the Latest Technologies. Tue, 10/02/2018 - 13:57. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Together we can ensure that Medicare beneficiaries see the impact of advances in 21 st century biomedicine.

Medicare 44

Medicare Medicare Payment Systems FDA 44

Health Populi

MAY 20, 2021

Year-on-year, different spikes and ups-and-downs call out for special mention, such as: Pharma’s 13-point steep dive to 38% between 2017 and 2018, dramatically recovering by 9 points in the last year to 47% [with the wild card here of whether U.S. to approve Medicare’s negotiation of drug prices with pharmaceutical companies].

COVID-19 124

COVID-19 COVID-19 Vaccine Health Insurance Medicare 124

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). 2018), rev’d in part on other grounds sub nom. UnitedHealthcare challenged the current Overpayment Rule in litigation. [1] FOOTNOTES. [1]

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

McGuire Wood

MARCH 31, 2022

Founded in 1989, the company focuses on long-term care and Medicare supplement plans. Founded in 2018, the firm seeks to invest $10 million to $25 million per platform and targets companies in healthcare IT and a few other sectors with between $10 million and $100 million in revenue. CHCS , based in Pensacola, Fla.,

Medicare 52

Medicare Medicare 52

Healthcare Compliance Blog

JANUARY 14, 2022

million to settle allegations that the company sold custom fabricated shoe inserts to Medicare recipients that did not meet Medicare standards. Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. A Florida based diabetic shoe company has agreed to pay over $5.5

Medicare 59

Medicare Medicare Medicaid Medicaid 59

CMS.gov

NOVEMBER 16, 2018

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Fri, 11/16/2018 - 18:51. Director, Medicare-Medicaid Coordination Office, Topic. Medicare Parts A & B. Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Tim Engelhardt.

Medicare 35

Medicare Medicare Medicaid Medicaid 35