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Reduced Co-Insurance for Screening Colonoscopies

Medisys Compliance

For dates of service calendar years 2027-2029, the reduced coinsurance is 10%. In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies.

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Capitation Rates Announcement for CY 2025

Innovaare Compliance

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% The base beneficiary premium (BBP) will be capped at 6% from prior year from 2024 to 2029 [3]. or $16 billion in 2025 over 2024 in expected MA payments.

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Rate Announcement for CY 2025

Innovaare Compliance

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% The base beneficiary premium (BBP) will be capped at 6% from prior year from 2024 to 2029 [3]. or $16 billion in 2025 over 2024 in expected MA payments.

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Monitor Improper Payments for Part C and Part D with Medicare Audit and Monitoring Software

Innovaare Compliance

1] The Centers for Medicare & Medicaid Services (CMS) has to establish an annual Part B premium that will adequately fund projected Medicare spending and maintain an adequate reserve in case actual costs are higher than estimated. annually on average between 2021 and 2029 compared to 4.4% in 2021 to $170.00

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Health Provider News

Hall Render

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

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April-July 2022 State Regulatory Developments

New Jersey Healthcare Blog

New Expiration Date: March 8, 2029. The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. Effective Date: March 14, 2022 until March 14, 2029. New Expiration Date: May 4, 2029. Effective Date: March 8, 2022. On April 4, 2022, at 54 N.J.R.

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PBM Practices Receive Increased Federal Scrutiny

Healthcare Law Blog

Further, PBMs have been found to encourage drug innovation and generate savings on specialty medications, and they are expected to save plan sponsors and consumers more than $1 trillion from 2020 to 2029. On March 1, 2023, the House Committee on Oversight and Accountability launched an investigation into PBM practices.