Bill of Health

JULY 15, 2022

What to Know About the Alzheimer Drug Aducanumab (Aduhelm). 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.

Public Health 205

Public Health Medicare Medicare Governance 205

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

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

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

Healthcare IT Today

MAY 16, 2024

Founded in 2018, Myndshft is the only unified platform that streamlines prior authorization and related services for both medical and pharmacy benefits. Centers for Medicare & Medicaid Services and the National Coordinator for Health IT.

Medicaid 99

Medicaid Medicaid Medicare Medicare 99

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

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”). CMS appealed but did not challenge the court’s findings about the negligence standard. 2018), rev’d in part on other grounds sub nom.

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Healthcare IT News - Telehealth

MAY 13, 2020

Although research supported the efficacy of video telepsychiatry, the National Institute of Mental Health-funded study notes, only 5% of psychiatrists in the Medicare program had ever provided a telemedicine visit. "Psychiatrists were pleasantly surprised about how well it was going and about patient response."

Telemedicine 215

Telemedicine COVID-19 HIPAA Medicare 215

Healthcare IT Today

MARCH 5, 2024

The idea for RapidClaims originated in 2018 during Dushyant Mishra’s tenure at Abbott Healthcare when he observed the challenges faced by hospitals while interacting with multiple hospital owners and physicians. ” About RapidClaims RapidClaims is automating medical coding to help health organizations reduce claim denials from payors.

Hospitals 93

Hospitals Medicare Medicare 93

HIT Consultant

APRIL 3, 2023

Progress toward VBC adoption hasn’t achieved its potential yet, hovering around 60% of all payment models from 2018 to 2021, with the remaining 40% comprised of traditional fee for service (FFS). These risk-based care models are designed to encourage proactive care, better population health and reduced spending across the healthcare spectrum.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Bill of Health

JULY 26, 2022

billion acquisition of One Medical (NASDAQ: ONEM) by Amazon triggered significant hyperventilating about the transformative and immediate impact of this transaction on the health care industry. Amazon now has an important foothold in the Medicare market. By Michael Greeley. Last week’s $3.9

US Department of Health and Human Services 167

US Department of Health and Human Services Health Insurance HIPAA Medicare 167

C&M Health Law

APRIL 7, 2022

was preempted under ERISA and Medicare Part D. PCMA asserted that Medicare Part D preempted most of the same provisions, as well as a provision that prohibited charging pharmacies a service fee. The scope of Medicare Part D preemption was an issue of first impression in the Tenth Circuit. 36, § 6958, et seq. , See 42 U.S.C.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

DECEMBER 13, 2022

UpStream supports physicians operating under full-risk, value-based arrangements who are providing care to seniors on Medicare with an integrated platform that emphasizes care quality, health equity and total cost of care. About UpStream Healthcare. Morgan acted as sole placement agent.

Medicare 88

Medicare Medicare Nurses 88

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

Health Populi

APRIL 8, 2019

That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement. But the first chart tells the story about where retiree health care money currently goes: to insurance premiums and prescription drugs, and out-of-pocket payments for services (copays, coinsurance, and deductibles).

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108

Health Care Law Brief

JUNE 26, 2022

Under the traditional, or fee-for-service (FFS), Medicare program, CMS directly pays providers a predetermined rate for the items and services furnished to patients under Medicare Parts A and B. CMS’s Payments to MA Plans. In turn, an MA plan pays providers a negotiated rate for the items and services they render to enrollees.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Health Populi

DECEMBER 19, 2018

mid-terms elections in the first week of November, 2018. Underneath this statistic, it’s important to compare the payor mix of patients delaying care: nearly one-third of people with private, commercial insurance delayed care by 2018; 22% of people enrolled in Medicaid or Medicare put off care. And, 19% of U.S.

Medicaid 84

Medicaid Medicaid Medicare Medicare 84

Health Populi

FEBRUARY 10, 2020

Even with the prospect of enrolling in Medicare sooner in a year or two or three, Americans approaching retirement are growing concerned about health care costs, according to a study in JAMA Network Open. One-half said they weren’t confident in their ability to afford health insurance in or near retirement.

Health Insurance 104

Health Insurance Health Care Reform Federal Policy Medicare 104

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 As individuals continue to live longer beyond retirement and the U.S.

Nursing Homes 52

Nursing Homes Medicaid Medicaid Medicare 52

HIT Consultant

AUGUST 15, 2022

Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. Due to rapid growth of the 65-and-older portion of the population, Medicare expenditures are forecast to reach $1,559.4 – Continued increase in overall Medicare costs. About Ashish Kachru.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

JUNE 15, 2022

Becerra , the Supreme Court ruled the payment cuts made by the Department of Health and Human Services’ (“HHS”) Centers for Medicare & Medicaid Services (“CMS”) for 340B eligible outpatient drugs were not permissible under the governing statute. On June 15, in American Hospital Association v. Background.

Medicare 45

Medicare Medicare Hospitals Governance 45

Health Populi

AUGUST 24, 2020

Eight percent of doctors have closed their practices as a result of COVID-19, tallying about 16,000 closed practices. Two-thirds of doctors are also concerned about closure of practices due to COVID-19 causing great harm to patients. One-half of physicians in the U.S. On the payor front, large U.S.

COVID-19 154

COVID-19 Telemedicine Doctors Medicare 154

Healthcare IT Today

JULY 12, 2022

In this week’s #HITsm chat, naviHealth Executive Medical Director Dr. Melissa Urrea will take over the naviHealth Twitter account ( @naviHealthPAC ) to talk about “How to Address Social Determinants of Health in the Senior Population.” Social determinants of health (SDoH) can encompass many different aspects of life.

Medicare 106

Medicare Medicare 106

HIT Consultant

NOVEMBER 24, 2022

Health plans could, for example, consider covering OTC hearing devices as part of the hearing benefits package provided to their Medicare Advantage plan members. Health plans offering the OTC benefit can also leverage the opportunity to educate members about the significant role hearing aids can play in improving their overall health.

FDA 98

FDA Public Health Medicare Medicare 98

Medval Compliance Blog

MARCH 10, 2022

by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047). 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

CMS.gov

NOVEMBER 30, 2017

CMS releases its Measures Under Consideration List for 2018 pre-rulemaking. Medicare and other payers are rapidly moving toward a healthcare system that rewards high quality care while spending more wisely. keya.joy-bush@…. Thu, 11/30/2017 - 15:28. Kate Goodrich, M.D., Initiatives. Leadership. End-Stage Renal Disease. Physicians.

Nursing Homes 20

Nursing Homes Nurses Medicare Medicare 20

Provider Trust

JULY 26, 2023

The data included in provider directories is comprised of information about individual providers, groups of providers, or institutions, including what services they provide, the health plans and networks they participate in, and contact information and location details. Unfortunately, provider directories are often riddled with inaccuracies.

Medicaid 52

Medicaid Medicaid Compliance Medicare 52

Healthcare IT News - Telehealth

JUNE 26, 2020

Throughout 2018 and 2019, Northwell Health piloted small-scale programs in partnership with the Gary and Mary West Health Institute Collaboration to bring medical services virtually to the homes of their patients. Providers were able to see about six such patients per day, panelists noted, often with multiple hours of driving time.

COVID-19 185

COVID-19 Telemedicine Medicaid Medicaid 185

HIT Consultant

APRIL 20, 2022

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. Tom Zaubler, MD, Chief Medical Officer of NeuroFlow.

Medicare 98

Medicare Medicare Telemedicine Medicaid 98

Pharmacy Law Blog

MAY 14, 2018

The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license: 1. This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. About the Author: George F.

Licensing 40

Licensing Nurses Medicaid Medicaid 40

Pharmacy Law Blog

MAY 7, 2018

The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license: 1. This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. About the Author: George F.

Licensing 40

Licensing Nurses Medicaid Medicaid 40

Jane Sarashon

FEBRUARY 4, 2024

Weaving these ideas together is my mission in preparing a session to deliver at the upcoming AHIP 2024 conference in June, I’m thinking a lot about the evolving nature of health insurance, plans, and the organizations that provide them. Retail health-meets-Medicare. about simplifying healthcare and building trust with customers.

US Department of Health and Human Services 70

US Department of Health and Human Services Health Insurance Medicare Medicare 70

HIT Consultant

NOVEMBER 16, 2022

These potentially avoidable hospitalizations roughly cost Medicare over $1 billion annually, not to mention the personal toll on a frail population and their loved ones. The standard of care should be about on-time and face-to-face (virtual or on-site) visits. Further, almost 40% of hospital admissions are avoidable.

Nurses 52

Nurses Telemedicine Patient Satisfaction Medicare 52

Health Populi

APRIL 18, 2019

As Kaveh invoked the futuristic theme, I couldn’t help thinking about Elroy Jetson, pictured here in a kind of FaceTime/Skype-type visit with a clinician sometime in the future that Hanna-Barbera produced in my childhood. Telemedicine used to be about solving access to no care,” Kaveh introduced the conversation. Providence St.

Telemedicine 124

Telemedicine Doctors Medicare Medicare 124

Health Populi

JULY 26, 2022

The deal was announced on 21 July, with Amazon striking the price at about $3.9 Iora Health has focused on the Medicare-enrolled population, distinct from ONEM’s target patient market of younger, employed consumers. With PillPack, I wrote here in June 2018 that Amazon got 50 U.S. bn and MGM Studios for $8.5

Health Insurance 164

Health Insurance Doctors Medicare Medicare 164