The notion that a Republican administration would be inherently favorable to Medicare Advantage (MA) is being tested. From CMS’ decision to hold MA rates flat for next year, to the DOJ's continued enforcement actions related to MA billing and the OIG's heightened scrutiny of upcoding practices, MA stakeholders are preparing for a bumpy...
Last week, the Centers for Medicare and Medicaid Services (CMS) published the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Hospital outpatient departments and ASCs will receive a 2.9% raise next year.
The boost includes a 3.4% market basket boost...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced this week that it would expand coverage for PET scans used in the diagnosis of Alzheimer's disease.
CMS has been hesitant to open reimbursements for the procedure, and the agency has long said that it would only cover one brain scan per beneficiary for a patient's...
The U.S. Supreme Court heard arguments last week on an issue regarding retail pharmacies overcharging government health plans that could compromise the False Claims Act.
The case dates from 2006, when Walmart offered unsustainably low drug prices to cash customers and charged Medicare and Medicaid plans far higher than the original...
Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) lessened penalties for the Hospital Readmissions Reductions Program (HRRP), a Medicare program that evaluates how often patients return to a hospital within 30 days and reduces payments for hospitals with higher readmission rates. But while many hospitals...
As seniors, the Centers for Medicare and Medicaid Services (CMS) and Medicare Advantage (MA) plans gear up for a landmark Medicare Advantage Open Enrollment Period beginning October 15, Medicare Advantage on the whole is in hot water.
Last week, the New York Times published an earthshaking story documenting the extent to which...
While Medicare Advantage plans are rapidly gaining steam and moving far faster than predicted to cover over half of eligible Medicare beneficiaries, watchdog scrutiny is ramping up to identify and curb predatory practices that may be harming beneficiaries and the bottom line of the Medicare program.
Last week, the U.S. House Committee...National News
In addition to overturning Roe v. Wade and with it abortion access for millions of American women, the Supreme Court ended their term this year with a slew of other decisions that will carry new precedent for health industry legal cases going forward.
Last Friday, the high court announced an end to a years-long fight between the U.S....National News
A study released this week found the rate of recovery and the length of a patient’s stay at a nursing facility are correlated with a patient’s mobility and their ability to care for themselves. This contributes evidence that Medicare’s bundled-payment program could negatively affect nursing homes and rehabilitation...National News
A group of laboratories lost their challenge against the definition of "applicable laboratories" under the Protecting Access to Medicare Act of 2014 because did not account for a majority of hospital labs when calculating Medicare reimbursements.
At stake were billions of dollars in Medicare reimbursements that federal judge Amy...
The proposal would reduce Medicare payment rates by 30 percent for some services at hospital-affiliated free-standing emergency departments that are located within 6 miles of an on-campus hospital emergency department.
NPR reports free-standing emergency departments have been cropping up across the U.S. in recent years and now number...
