The article discusses the final rules released by Centers for Medicare & Medicaid Services (CMS) outlining how Medicare will pay major health providers and suppliers in 2015. Topics discussed include a shift in the focus of health care systems to better health outcomes, coordinating care and ...
The Centers for Medicare & Medicaid Services (CMS)recently announcedthat for Medicare Advantage (MA) beneficiaries in particular, it has finalized requirements that will increase access to telehealth, expand the types of supplemental benefits available for patients with chronic diseases, provide support f...
On December 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule with technical changes for the Medicare Advantage (MA) Program and the Medicare Prescription Drug Benefit Program for Calendar Year 2026 (Proposed Rule). Citing the growing u...
On November 26, 2024, Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule revising the Medicare Advantage (“MA”) Program (Part C), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, and Programs of All-Incl...
The CMS Interoperability and Prior Authorization Rules Podcast — Drug Pricing: How Are Payers Responding to the IRA? Findings from Gibbins’ Annual Healthcare Bankruptcy Report A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration ...
The Centers for Medicare & Medicaid Services (“CMS”) has announced its proposed rules for theHospital Outpatient Prospective Payment (“OPPS”) and Ambulatory Surgical Center (“ASC”) Payment Systems, as well as its calendar year (CY)2024 proposed Physician Fee Schedule(“PFS”), (colle...
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The Centers for Medicare & Medicaid Services (CMS) is the agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs. The CMS oversees programs, including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), ...
In order to protect Medicare program integrity, CMS is now requiring a positive COVID-19 laboratory test on all claims eligible for the add-on payment. “CMS may conduct post-payment medical review to confirm the presence of a positive COVID-19 laboratory test and, if ...
CMS would also require insurers to report certain prior authorization metrics by posting them online each year. The proposed rules would apply to most Medicare and Medicaid patients. If finalized, these prior authorization policies would take effect January 1, 2026, with the initial set of metrics...