Health Care Law Brief

APRIL 3, 2023

Based on public comments from the Advance Notice, CMS will implement these changes subject to the Phase In and anticipates that by 2026 100% of the risk scores will be calculated using the updated model in the Rate Announcement. See 88 Fed. 6643 (Feb.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

MAY 5, 2023

billion by 2026 , driven in part by direct-to-consumer testing for health risks such as breast cancer and physician orders for prenatal testing, tumor molecular profiling and sequencing to diagnose rare disease. Such scenarios demand vigilance from health plans and new approaches to preventing inappropriate billing before it starts.

Fraud 62

Fraud Medicare Medicare Overpayments 62

Hall Render

JUNE 22, 2022

The proposed reduction to home health reimbursement stems from the requirement that CMS “annually determine the impact of differences between assumed behavior changes … and actual behavior changes on estimated aggregate expenditures” under PDGM every year from 2020 to 2026.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Healthcare Law Blog

JANUARY 5, 2023

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.

Medicare 52

Medicare Medicare Medicaid Medicaid 52