2017 Request For Information (“RFI”): CMS solicited stakeholder feedback on the definition of “negotiated prices” through an RFI in the Federal Register.12In the RFI, CMS stated that its “reasonably determined” exception was not as narrow as the agency claimed...
Highlighting Variability in Medicare Payments for Anesthesia Units: Rural Pass-throughversusMedicare Anesthesia Conversion Factordoi:10.1097/ALN.0000000000005249Caroline L. EnsorJohnathan L. PreglerAmr AbouleishNeal H. CohenThomas R. MillerJonathan S. Gal...
devices. The Secretary must promulgate, through the use of a program memorandum, initial categories that would encompass each of the individual devices that the Secretary had designated as qualifying for the pass-through payments to date. ...
When you become eligible for Medicare but still have coverage through an employer/union or other group health plan, you will receive a notice of Creditable Coverage. You will receive this notice annually from your employer/union in September. The Notice of Creditable Coverage will state whether yo...
services that do not otherwise qualify for coverage under the Medicare statute are not included, nor are other CMS-recognized innovative but non-breakthrough technologies, for instance non-breakthrough devices that are eligible for New Technology Add-on Payments or Transitional Pass-Through Payments. ...
Under the Quality Payment Program, clinicians are able to earn a 5% incentive payment through participation in qualifying Advanced Alternative Payment Models. Wave 2 facilities may have been aware of the potential incentive payments for participation in an Advanced Alternative Payment M...
While these drugs are excluded from basic Part D coverage, drug plans can include them as a supplemental benefit, provided they otherwise meet the definition of a Part D drug. However plans that cover excluded drugs are not allowed to pass on those costs to Medicare, and plans are required ...
Traditional PBMs are typically not transparent about rebates, which can encourage high-cost drug use, whereas transparent fee-based PBMs pass rebates and discounts onto payers and earn revenue through a clear administrative fee. Payer organizations have turned to the federal government to get ...
but it’s going to be a bigger problem given the size of Medicare Advantage – is that managed care is by definition managed, including through utilization management, which one hopes at least is evidence-based and that there is an effort to see whether particular utilization of an expensive ...
If Medicare reform is urgent for the sake of our most vulnerable retirees, it is also necessary for the sake of our health-care system. By subsidizing the massive over-utilization of health-care resources, and by underpaying doctors and physicians (who must pass on the costs to patients with...