The Centers for Medicare and Medicaid Services will now cover lung cancer screenings for Medicare beneficiaries when they turn 50 instead of 55 and if they have a 20-pack year smoking history instead of 30-pack year. The update in eligibility follows similar guidelines enacted by the U.S. ...
they only receive 85 percent of the total Medicare rate. The primary issue around split/shared services is deciding who provides the "substantive" portion of the service and can therefore bill for it. In the CY 2022 MPFS final rule, CMS created a policy that...
Ensuring automatic enrollment of Supplemental Security Income recipients into the Qualified Medicare Beneficiary group, with limited exceptions. Additionally, the Proposed Rule includes changes specific to CHIP enrollment. The changes include: Allowing beneficiaries who fail to pay premiums to stay enrolled ...
, the Centers for Medicare & Medicaid Services (“CMS”) released the U.S. Department of Health and Human Services (“HHS”) Notice of Benefit and Payment Parameters for 2024 Final Rule (the “Notice”) that includes standards for issuers and Marketplaces, and requirements for agents, brokers...
between what they were paid for 340B drugs for 2018–2022 and what they would have been paid had the 340B payment policy not applied. CMS is accounting for Medicare beneficiary cost-sharing in the lump-sum payments, and thus providers may not bill Medicare beneficiaries for any cost-sharing...
is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines....
CMS has prohibited ads that don’t mention a specific plan name as well as any ads that could use “words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing or misrepresents the plan,” the agency said. ...
Section 1862(a)(2) of the Social Security Act prohibits Medicare from paying for items or services for individuals who have no obligation to pay for those items or services. This "no legal obligation to pay" payment exclusion means that Medicare cannot cover items or services for individua...
On March 15, 2023, the Centers for Medicare & Medicaid Services (CMS) issued an initial guidance memorandum[1] on the Medicare Drug Price Negotiation Program (Negotiation Program) created by the Inflation Reduction Act of 2022 (IRA). Public comments are due to CMS by April 14, 2023. CMS ...
The Million Hearts Cardiovascular Risk Reduction Model of the US Centers for Medicare & Medicaid Services (CMS) prevented 1 death for every 191 medium-risk and high-risk beneficiaries with no effect on Medicare spending.1,2The model met the US Center for Medicare and Medicaid Inn...