About 13% of prior authorization requests that are denied by Medicare Advantage plans actually met Medicare coverage rules and should have been approved, the Office of the Inspector General at the US Department of Health and Human Services reported last year. The newly finalized rule now requires ...
The article focuses on the revised regulations on medicare reimbursement for tracheoesophageal voice prosthesis (TEP) which is being challenged by the American Speech-Language-Hearing Association (ASHA). It states that the rules allow laryngectomy patients to purchase an extra TEP in case of ...
With every new year, comes new changes, rules, and laws. Some are good, some not so good. One good change that happened for 2023 for those on Social Security not just in New York State, but the entire country, was a monthly increase put into place at 8.7 percent. That's the largest...
New Medicare Rules. The New Medicare Rules.The New Medicare Rules.The author reflects on the proposed changes to Medicare rules.TergesenAnneEBSCO_bspWall Street Journal Eastern Edition
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,...
In the absence of regulation, several lawsuits have been filed against insurers for their use of AI-based algorithms. The families of two deceased Medicare Advantage recipients who lived in Minnesotasued UnitedHealthin 2023, stating that the company’s algorithm had a 90% error rate and was il...
the annual cost to Medicare could be as much as $26.8 billion. But payers are talking about the costs while remaining silent on the benefits. In 2023, according to the U.S. Joint Economic Committee, obesity caused $5,155 in average excess medical costs per person diagnosed as obese. That...
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 market...
New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors. New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors. Some ...
The Centers for Medicare & Medicaid Services hasn’t approved Leqembi for everyone on Medicare yet either. For now, the same rules apply to Leqembi as they do Aduhelm. “The next questions will be whether Medicare covers it, how much would it cover, and under what setting,” says Dr. ...