4月4日,美国医保局(CMS)发布了2025年的Medicare Advantage和Medicare Part D的最终版规则,其中对生物类似药替代的要求明显降低,Medicare Part D的所有生物类似药替换不再明确要求CMS的提前批准,而此前这一原则仅适用于可互换的(interchangeable)生物类似药。 在此之前,任何生物药处方的变更中,CMS规定保险公司、PBM或...
ET on March 1, 2024, and CMS will announce the MA capitation rates and final payment policies for CY 2025 by April 1, 2024. The Centers for Medicare & Medicaid Services (CMS) released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA)...
On February 6, 2024, CMS released anFAQ memoclarifying how a new Medicare rule (Final Rule) and the Affordable Care Act impact the use of AI and algorithms by MA organizations in making Medicare Advantage coverage determinations. The final rule (CMS Final Rule, CMS-4201-F) ...
The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (MPFS) and Other Revisions to Medicare Part B (CMS-1784-P) Proposed Rule, which includes proposals related to Medicare physician ...
Furthermore, health plans require more incentives to address health-related social needs for their beneficiaries and facilitate the uptake of non-medical benefits. In Medicare Advantage plans (representing 34% of Medicare beneficiaries), only 20.8% of Medicare Advantage enrollees are in a plan that ...
August 16th 2024 5 Things Medicare Advantage Plans Can Do to Improve Their Star Ratings Brooke McCormick Health plans can improve their Medicare Advantage Star Ratings by focusing on member relationships, ensuring proper documentation, grouping measures, staying updated with regulatory changes, and optim...
2024 Medicare Advantage and Part D proposed rules published on December 14, 2022. It continues the trend of regulatory enhancements to the Medicare Advantage and Part D programs and in practice creates additional administrative requirements for Medicare Advantage organizations (MAOs) and Part ...
The article reports on the regulations proposed by the Centers For Medicare and Medicaid Services (CMS) that would improve marketing and operations oversight on insurers providing Medicare Advantage and prescription programs ...
Medical Association CPT Editorial Panel earlier in 2023 to report the insertion or replacement of the device in patients with bladder dysfunction. The reporting of procedures with this device to Medicare, Medicare Advantage, and commercial health plans will be effective starting on January 1, 2024...
In the latest update of the WCMSA reference guide, Medicare Advantage Plans continue to be spotlighted.In Section 4.1.3, CMS states: CMS notifies Part C and D plan sponsors that a WCMSA has been approved and instructs plan sponsors to conduct Medicare Secondary Payer (MSP) investigations. ...