CMS Updates Medicare Readmissions Policy, Other Quality InitiativesVarun Saxena
As the OCM practices work to reduce Medicare’s overall spending on those patients and to earn shared savings payments, the data are providing them with an unprecedented full picture of the extent and cost of care. “When it first came out, the reaction was, ‘Wow,’” said Robert “Bo”...
owe a payment back to CMS (a "downside risk payment"), or neither receive nor owe a payment. Lump-sum payments will be made to the participants, in addition to the Medicare fee-for-service payments, following the close of each performance year. ...
The Centers for Medicare & Medicaid Services (CMS) is expanding its social determinants of health (SDoH) initiatives to include outpatient settings, starting with voluntary reporting in 2025 and moving to mandatory reporting in 2026, MedLearn Publishing August 26 reports. This expansion aims to addre...
CMS is also trying to make improvements to Medicare Advantage and Part D Star Ratings to allow consumers to identify high-value plans. The final rule is supposed to improve the quality of care for beneficiaries dually eligible for Medicare and Medicaid who participate in Dual Eligible Special Need...
Lastly, the U.S. Department of Health and Human Services' Office of Inspector General recently proposed changing the Anti-Kickback Statute safe harbors for drug discounts.[12]The rule would eliminate protection for certain drug manufacturer rebates to pharmacy benefit managers, Medicare Part D plans...
Currently, Bellese works with the Centers for Medicare & Medicaid Services, supporting price transparency, Medicare payment system modernization, and quality of care initiatives.Bellese holds the GSA IT 70 Schedule and two CMS agile blanket purchase agreements (BPA) — the Medicare Payment Syst...
CMS is seeking comments related to the alignment of the Hospital Price Transparency regulations with other price transparency initiatives such as the Transparency in Coverage regulation and the No Surprises Act. Notable CY 2024 Medicare PFS Proposals: Decrease the conversion factor by 3.34% to $...
Free Essay: Medicare & Medicaid Services(CMS) The Affordable Care Act(ACA) signed into law in 2010, one of the goal of ACA is to focus on quality of care...
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 individual...