About 13% of prior authorization requests that are denied by Medicare Advantage plans actually met Medicare coverage rules and should have been approved, theOffice of the Inspector Generalat the US Department of Health and Human Services reported last year. SUGGESTED for you The newly finalized rule...
Medicare regulators on Fridayfinalized rulesto pay for some mental health apps, a breakthrough for digital therapeutics companies that have struggled for a foothold in the health care system. The new rule creates codes that allow clinicians to bill Medicare for providing the apps and related service...
Every year, industry stakeholders anticipate the release of this annual regulation because it updates the rules governing Medicare’s value-based programs and physician payment system. The proposed rule is open for public comment through September 11. Following the close of the public comment period,...
The guidelines outline the Medicare Prescription Payment Plan, which will allow individuals with Part D prescription plans to spread the costs of their medications over the year instead of paying for each prescription all at once. The guidelines also require drug manufacturers, presc...
The updated CMS rules for TPMOs underscore the importance of transparency, informed consent, and responsible data sharing. By following these guidelines closely,TPMOs can demonstrate their commitment to protecting the privacy of Medicare beneficiaries, building trust in the healthcare marketpl...
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New Part D caps on out-of-pocket spending would limit beneficiaries' costs to $3,300 in 2024 and $2,000 in 2025, but KFF noted those are significant bites for people living on modest fixed incomes. It's possible Medicare could select semaglutide for drug price negotiation as early as 202...
On April 7, the Centers for Medicare & Medicaid Services (CMS) issued an update to the COVID-19 emergency declaration blanket waivers for specific providers. The memorandum, which was issued by the Director of the Quality, Safety & Oversight Group, details the numerous changes that will take ...
In October, Gov. Newsom signedSB 770by Senator Scott Wiener (D-San Francisco) “to force all Californians out of their existing health coverage – including Medicare, employer-based coverage and Affordable Care Act (Obamacare) plans – and into a new untested government-run system, with no ab...
New Rules for STHI People typically buy short-term health insurance plans to help cover specific gaps, such as when they are between jobs, when they’ve left a college health plan and are looking for a job, or after they’ve left a job and are waiting forMedicare co...