Orphan Drug Exclusion.CMS states that it has “clarified ... that a drug that has designations from the U.S. Food and Drug Administration (FDA) for more than one rare disease or condition will not qualify for the Orphan Drug Exclusion, even if the dru...
On July 22, 2024 the Centers for Medicare & Medicaid Services (CMS) released their data for theTop 10 Section 111 Non-Group Health Plan Reporting Errors January – June 2024. The chart with the list of errors and their rank can be viewed below. A downloadable PDF of this chart along wi...
Centers for Medicare & Medicaid Services (CMS) to update its list of clinical laboratory tests and billing codes. It was cited that the clinical laboratory tests and billing codes were approved by the Food & Drug Administration, as waived under the Clinical Laboratory Improvement Amendments (CLIA)...
CMS Announces Updated List of Drugs Under the Inflation Rebate Program Morgan Lewis - Health Law Scan on 10/24/2024 Bipartisan efforts to lower prescription drug costs remains a core focus for the US Congress. Effective October 1, 2024, the Centers for Medicare and Medicaid Services (CMS) ha...
Additionally, in the CY 2022 OPPS/ASC Final Rule, CMS finalized a proposal to codify five longstanding criteria for determining whether a service or procedure should be removed from the IPO list. For CY 2023, CMS removed 11 services from the IPO list based on the determination ...
Specifically, the Centers for Medicare and Medicaid Services will permit plans to include different indications, or uses, for prescription drugs. Currently, a Part D plan that places a medicine on its formulary must cover each indication that was approved by the Food and Drug Administration, even...
CMS proposes to add three services to the inpatient-only list, which includes services that should only be performed inpatient due to their complexity and the level of post-operative care required (CPT codes 0894T, 0895T and 0896T).
On September 5, 2024, CMSpublisheda list of 741 acute care hospitals (ACHs) that are required to participate in the Transforming Episode Accountability Model (TEAM). TEAM is a mandatory, episodic-based payment model that will bundle ACH payments for five types of surgical episodes. While the ...
Despite pushback from employees and some labor groups, more health systems are taking a hard stance on COVID-19 vaccination as a condition of employment. The FDA's full approval of the Pfizer-BioNTech shot added a new wave of providers to the list. (Getty/FG Trade) ...
for items and services provided for that discharge. The median payer-specific negotiated charge for payers that are MA organizations (for that MS-DRG) would be the median payer-specific negotiated charge in that list of discharges. This process would also be applied to other third-party payers....