According to CMS, because the Part D redesign reduces the reinsurance percentage in CY 2025, using the existing methodology for calculating prospective reinsurance payments would result in CMS prospectively paying significantly more for employer group waiver plans (EGWPs) than necessary for CY 20...
After you receive services from a doctor who doesn’t accept the assignment but is still part of the Medicare program, you can receive reimbursement. But you must file a claim to Medicare asking for reimbursement by filling out the CMS-1490S form to ask for payment. The service provider wil...
The original transmittal was published regarding implementation of the Chronic Kidney Disease Quarterly Capitation Payment mechanism and to implement various benefit enhancements, including telehealth, post-discharge home visit, 3-day SNF rule waiver benefit enhancements, and more. Effective date: April 1...
(See “Employer Group Waiver Plans.”) In addition, the MMA provides separate subsidies for employers that agree to provide retiree drug benefits outside of Medicare, as an incentive for employers to continue offering retiree health benefits. (See “Retiree Drug Subsidy.”) The Part D program...