The Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that takes aim at prescription drug costs in Medicare Advantage (MA) and Medicare Part D plans. The agency said the rule would reduce out-of-pocket costs for beneficiaries and improve price transparency as well as "market competition in the Part D...National News
Medicare Advantage and the hundreds of investors pumping venture capital into new MA startups rely on one thing: MA growth. For the past several years, MA has been on a quick trend upward, but as it currently only captures under 50% of the market, some are left wondering if the seemingly endless demand isn't just a giant investment...
On Tuesday, President Joe Biden addressed the nation in an attempt to calm fears about skyrocketing COVID-19 cases and overwhelmed hospitals across the country. The president leaned on the vaccine for mitigating hospitalization rates as the cases continue to surge due to the highly-transmissible Omicron variant of the virus.
We have in...
The Omicron variant of SARS-CoV-2 has surged in the United States in the past week and now accounts for 73% of new infections. The CDC showed a six-fold increase in Omicron infection in a single week. In the New York area, the Southeast and the Pacific Northwest, the variant is responsible for an estimated 90% of new infections,...
On December 14, there were 116,892 new cases of COVID-19 reported in the United States and the seven day case average is 120,719. On December 15, the nation added 1,285 new deaths and crossed the 800,000 mark for deaths related to the coronavirus. About 61% of Americans are fully vaccinated and two million doses are administered daily,...
The a rolling 7-day average in the United States is now 1,319 deaths per day. On December 6, there were 113,992 new cases of COVID-19 reported nationwide. Over 60,000 Americans are currently hospitalized with complications from COVID-19.
Only 60% of the country is fully vaccinated with 71% of the population having received at least...
Last Tuesday, providers gathered in Washington, D.C. to advocate against the Medicare direct contracting program, arguing that it could become the end of Medicare.
Members of Physicians for a national Health Program (PNHP), which supports a single-payer healthcare system brought petitions to appeal to U.S. Department of Health and...
The Omicron variant was first identified in South Africa and prompted concerns among scientists and global public health officials because it carries an unusually high number of mutations. The World Health Organization has called Omicron a "variant of concern". Cases have been identified in 20 countries so far, including the United...
The Medicare enrollment period has surpassed the halfway point for the 2022 calendar year (CY) and trends are already apparent. Supplemental benefits and in-home services are demonstrating huge gains for Medicare Advantage (MA) plans that offer them, although the $0 premium remains the most consistent choice for enrollees.
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Nationwide, cases of COVID-19 appear to be on another up-swing. On November 16, there were nearly 90,000 cases reported nationally, following a seven-day average of 88,000 cases per day. There were 1,414 deaths on the 16th, and the total national deaths due to COVID-19 has reached 765,000. Nearly 60% of the country is fully vaccinated...
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that included changes to the physician fee schedule (PFS) and changes to payments for Medicare Part B. The agency also announced an increase in Part B beneficiary premiums due in part to the authorization of the controversial Alzheimer's drug Aduhelm,...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) updated its guidance for nursing home visitations during the COVID-19 pandemic this week. Although the guidance relaxes previous regulations, the agency notes its concern for the vaccination rates of nursing home employees. Unfortunately, unlike most other areas of the medical...
The COVID-19 vaccine has been approved for distribution in children as Pfizer now moves to request authorization from the Food and Drug Administration to recommend booster shots for all adults six months after vaccination. Meanwhile, the vaccine mandate has ruffled feathers of both big businesses and conservative leadership at the state...
On Tuesday, the Centers for Medicare and Medicaid Services issued a final rule for the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS). The PFS includes policy changes for Medicare payments and Medicare Part B, and is the major mechanism for rate setting for the Medicare program as a whole. The PFS must remain budget...National News
On Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced the final Outpatient Prospective Payment System (OPPS) rule for 2022. The final rule contains a substantial hike in the civil monetary penalty for hospitals not complying with price transparency rules, with a minimum $300 per day for hospitals with 30 or fewer...Arizona News
The Next Generation accountable care organization (Next Gen ACO) alternative payment model will end in 2022, but not before it saved Medicare some significant money, according to new data from the Centers for Medicare and Medicaid Services (CMS). CMS found that in 2020, the Next Gen model saved $637 million on the whole, but that number...
Medicare Advantage is under pressure to demonstrate its cost-savings for the Medicare program following a report for the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) that suggests Medicare Advantage (MA) plans "may have inappropriately" leveraged chart reviews and health risk assessments to...
Last week, the National Association of ACOs (NAACOS) sent a letter to the Centers for Medicare and Medicaid Services (CMS) requesting leniency regarding performance benchmarks and the potential option for accountable care organizations to select pre-pandemic years as the basis for benchmark measurements. Additionally, CMS announced the...National News
A bipartisan group of senators, including Senators Kyrsten Sinema (D-AZ) and Mark Kelly (D-AZ), sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure last Friday, warning against any potential cuts to the Medicare Advantage (MA) program. The letter comes as Democrats look for places to...
The Centers for Medicare and Medicaid Services (CMS) released its star ratings for Medicare Advantage Part C and Part D star ratings last Thursday, ahead of Medicare open enrollment, which begins October 15. Medicare Advantage (MA) plans get a star rating from one to five each year based on performance metrics including patient...
