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Posts tagged with "CMS"

Nursing Home Claims Audits to Begin Next Week National News

Nursing Home Claims Audits to Begin Next Week

Beginning next week, every skilled nursing facility in the country will undergo a five-claim audit as the Centers for Medicare and Medicaid Services (CMS) aims to get improper payments under control. Meanwhile, nursing homes are expressing concern about the effects that Medicaid redeterminations and subsequent disenrollment's could have...
CMS Rules

Medicaid Redeterminations Have Started for 19 States, Some Concerned by High Disenrollment Volume

As states proceed with Medicaid redeterminations after three years of a pause on eligibility review, hundreds of thousands of Americans are losing insurance coverage, according to early data reports. The Centers for Medicare and Medicaid Services (CMS) are stressing the importance of limiting the number of lost enrollees and facilitating...
White Papers, E books, Reports and more

CMS REPORT: Dual Eligible MA Enrollees Receive Worse Care

A new study shows that dually eligible Medicare Advantage enrollees received poorer clinical care than those who were not dually enrolled. The Centers for Medicare and Medicaid Services  (CMS) Office of Minority Health (OMH) released a report this week based on analysis of Healthcare Effectiveness Data and Information Set (HEDIS),...
CMS Rules

New Proposed Rule Takes Aim at PBMs and Managed Care

The Biden administration issued a proposed rule through the Centers for Medicare and Medicaid Services that aims to increase transparency of prescription drug costs and managed care plan operations for Medicaid enrollees. It would do this by implementing a new drug price verification survey tool and requiring the inclusion of drug...
National News

Alzheimer's Treatment Leqembi May Be Authorized by CMS Despite Hefty Price Tag

Support for Medicare coverage of the anti-Alzheimer's drug Leqembi is growing on Capitol Hill, but estimates of the drug's cost may prove to be prohibitive for the Medicare program. Coverage of the drug through the Medicare program would raise costs for the program by $2 billion to $5 billion per year, according to a new study by...
National News

Reproductive Health Update May 18, 2023

A new report revealed dozens of examples in which medical care for pregnant patients was different than care they would have received before the Supreme Court overturned Roe v. Wade last June. The report was conducted by the University of California at San Francisco's Advancing New Standards in Reproductive Health (ANSIRH) research...
CMS Rules

CMS Announces SNF Claims Will Be Scrutinized More Closely

The Centers for Medicare and Medicaid Services (CMS) published a memo concerning a crackdown on improper claims for skilled nursing facilities. CMS also announced that it would begin a demonstration for inpatient rehabilitation facilities in Alabama that will allow all Medicare claims to be subject to review. As of June 5, all SNFs...
The PHE Is Over! Waivers Reversed, CDC Director Walensky Resigns National News

The PHE Is Over! Waivers Reversed, CDC Director Walensky Resigns

Today is the last day of the COVID-19 public health emergency (PHE), and policies are rapidly shifting to accommodate the post-pandemic healthcare landscape in the U.S. On Tuesday, the Drug Enforcement Administration (DEA) announced that it would continue allowances for telehealth companies to prescribe controlled substances for six...
White Papers, E books, Reports and more

Report: MGMA Members Say PA Leads to Delays, Denials of Care

The Medical Group Management Association (MGMA) published a report last week on the issues brought about by Medicare Advantage (MA) plans' use of prior authorization. MGMA surveyed 600 medical groups on the use of PA and found that it contributes to increased costs and delays or denials of care. Groups overwhelmingly reported that...
National News

New Medicaid Rules Aim to Shorten Patient Wait Times, Increase Pay for Home Health Aides

Last week, the Centers for Medicare and Medicaid Services (CMS) proposed two new rules that would require private entities that manage Medicaid and Children's Health Insurance Plan (CHIP) plans to enforce national maximum standards for appointment wait times and will require managed care organizations (MCOs) to monitor compliance. The...
National News

Eli Lilly Poised to Release Findings in Alzheimer's Treatment Study

As pressure mounts from stakeholders and lawmakers, Eli Lilly, producer of the experimental Alzheimer's antibody drug donanemab, is saying that it expects the Centers for Medicare and Medicaid Services (CMS) to reverse its prohibition of anti-amyloids. A bipartisan group of nearly half of U.S. state attorneys general sent a letter to...
News

Reproductive Health Update May 4, 2023

Arizona Attorney General Kris Mayes told the Arizona Supreme Court that her office's decision to not enforce a Territorial era abortion ban means that no one can enforce the ban. The U.S. Department of Health and Human Services (HHS) has launched an investigation that could lead to enforcement of the Emergency Labor and Transport Act...
Humana Posts MA Boost, Centene Frustrated by CMS Rules and Medicaid Unwinding National News

Humana Posts MA Boost, Centene Frustrated by CMS Rules and Medicaid Unwinding

Humana has revised its outlook, confident that its expected Medicare Advantage enrollment will increase even more than it originally anticipated in 2023. But Centene has reported the opposite, expecting to lose money in Medicare Advantage and from Medicaid redeterminations. Centene released its first quarter (Q1) corporate reports on...
Groups Call on Sec. Becerra to Crack Down on Medicaid Redetermination Process, ACA Has Enrollment Issues of Its Own National News

Groups Call on Sec. Becerra to Crack Down on Medicaid Redetermination Process, ACA Has Enrollment Issues of Its Own

The first Medicaid redeterminations since the beginning of the COVID-19 pandemic have been underway in at least five states since the beginning of the month. Health advocacy groups are pressuring U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra to ensure that a "health equity and civil rights disaster" does not...
CMS Rules

CMS Streamlines Prior Authorization for MA in New Rule

Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms. The rule stipulates that once a health plan grants prior authorization for a service, the approval will...
CMS Backtracks on 2024 MA Rate Notice and Part D Rule Changes CMS Rules

CMS Backtracks on 2024 MA Rate Notice and Part D Rule Changes

Published Friday, the rate notice includes a 3.32% overall pay raise which was up from the 1.03% in the proposed rule. The Centers for Medicare and Medicaid Services (CMS) appears to have ceded to the demands of the insurance industry; the new pay rates translate to a $13.8 billion increase for insurers, according to Axios, CMS will...
CMS Proposes SNF FY 2024 Rates CMS Rules

CMS Proposes SNF FY 2024 Rates

On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed the FY 2024 Skilled Nursing Facility (SNF) Payment Prospective Systems (PPS) rates. It includes an increase of 3.7%, or $1.2 billion in Medicare Part A payments to SNFs. The rate increase reflects a 6.1% market basket update to the payment rates comprised of a...
CMS Proposed Hospice Rule Includes Crackdown on Hospice Fraud CMS Rules

CMS Proposed Hospice Rule Includes Crackdown on Hospice Fraud

On Friday, the Centers for Medicare and Medicaid Services issued a proposed rule that would give hospice providers a 2.8% reimbursement increase and would institute a number of penalties for hospices that fail to meet reporting requirements. The rule signals a long-expected federal crackdown on hospice fraud, waste and...
Most Provider Directory Entries Inaccurate National News

Most Provider Directory Entries Inaccurate

New research shows 83% of entries in provider directories from America's leading insurers were inaccurate. Most providers listed in directories from Aetna, Elevance, Cigna, Humana, and UnitedHealth had inaccuracies, but specialty information was much more likely to be accurate. Only 27.9% of physicians had consistently accurate...
Secretary Becerra Heads to the Front Lines of the Fight with MA Over the 2024 Advanced Notice CMS Rules

Secretary Becerra Heads to the Front Lines of the Fight with MA Over the 2024 Advanced Notice

Lawmakers and stakeholders are still very upset with the U.S. Department of Health and Human Services' (HHS) plan to cut payments to the Medicare Advantage (MA) program and to enforce regulations against MA plans that have benefitted financially from improper overpayments. This week, HHS Secretary Xavier Becerra defended the rule in two...
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Jun 24 @ 7:30 am – 11:30 am
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