In CY 2020, CMS established a nationwide prior authorization process and requirements for certain outpatient department (OPD) services. Providers must submit a prior authorization request to the Medicare Administrative Contractor (MAC) for services included on the list of OPD services that require p...
Plans must notify enrollees annually in writing of their ability to opt out of phone calls regarding MAP and PDP business. Confirmed that the prohibition on door-to-door contact without an appointment still applies after collection of a business reply card or scope of appointment (SOA...
CMS proposed extensive changes to Medicare marketing. The Final Rule includes limits on how marketing may use the Medicare name, logo, and card; prohibitions on advertising benefits that are not available in the service area; and
Manufacturers of novel technologies would be able to opt in to MCIT by notifying CMS of is intention to use the pathway. Devices participating in FDA’s Breakthrough Device Program would be eligible for MCIT, and any MCIT-participating device must fit within a statutory Medicare benefit category....
CMS is also requiring impacted payers to maintain an attribution process to associate patients with in-network or enrolled providers with whom they have a treatment relationship and to allow patients to opt out of having their data available to providers under these requirements. Impacted payers will...
1 Broadly, the CMS criteria require beneficiaries to have multiple chronic conditions selected from a list of qualifying conditions, use specific medications covered by Medicare Part D, and meet a specified total estimated annual medication cost covered by Medicare Part D.1 Sponsors, which are the ...
To accomplish this, you will need to develop a list of “changing scenario facts” that you will, as the exercise progresses, hand to the TT team (on a slip of paper or text/email/etc.) Things like: unplanned-for freeways closure, fuel shortages, stranded employees, generator failure, si...
On September 30, 2021, the Centers for Medicare and Medicaid Services (CMS)issued an interim final rule(IFR) to address large out-of-pocket costs to consumers from “surprise billing.” This IFR is the second set of rulemaking from the Biden Administration that implements the No Surprises Act...
In a blog post, CMS announced changes to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) that will allow physician practices to choose the level and pace at which they comply with the new payment reform model aimed at emphasizing quality patient care over volume. The announcement...