At the end of last month, CMS proposed a rule to change some key components of prescription coverage for Medicare Part D and Medicare Advantage beneficiaries. The key change revolves around the six protected classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for transplant rejections, antiretrovirals and antineoplastics (typically cancer treatment drugs). The six protected classes acknowledge that […]
Last week at a symposium in Washington D.C., Health and Human Services (HHS) Secretary Alex Azar, stated the Center for Medicare and Medicaid Innovation is trying to identify “solutions for the whole person, including addressing housing, nutrition and other social needs.” This initiative would allow hospitals to pay for housing and healthy food for patients.
November sees the publishing of Medicare’s final rules for 2019. It has allowed for sweeping changes to Telehealth, provider reimbursement and Quality reporting. Medicare will now reimburse for patients connecting with their provider in a telecommute session to determine if an in-office visit is necessary. Changes made to the Quality Payment Program (QPP) will shift
Last week, the Trump administration announced the first mandatory CMS pay model to reign in the cost of prescription drugs. This proposal from the Department of Health & Human Services is a two-step process. One would be to decrease drug rates paid by Medicare Part B by indexing them to be in line with the
The Patient-Centered Evaluation and Management Services Coalition submitted an open letter to Congress in September sharing their concerns over the new proposed 2019 rule. For more on the details of this rule, check out Part 1 and Part 2. Their concerns are not only over the new payment structure but the documentation guidelines as well:
We have talked about managing denials in the past, but have rarely gotten payor specific. In this recent article from Healthcaredive.com, they targeted in on Medicare Advantage plans. This stems from an investigation by the HHS Office of Inspector General. They have discovered a high number of overturned denials for Medicare Advantage organizations. Three-fourths between
Last week saw a push from hospitals to lobby lawmakers about CMS’s proposal for site neutral payments. The site neutral payment proposal would be to pay the same rate for services delivered at off-campus hospital outpatient departments and independent doctor’s offices. According to CMS, they could save $610 million and patients could save $150 million
Insufficient documentation is the root cause for most of CMS’s improper payments. For example, according to the Medicare-Fee-For-Service 2016 Improper Payments Report, CMS paid $36.3 billion in improper payments, 64.1% of which were attributed to insufficient documentation. The guiding rule is if it didn’t happen in the documentation, then it didn’t happen at all. The
We have talked a lot over the last month or so about the proposed changes to E&M Coding and reimbursement. There are additional proposed changes we want to make sure you are aware of as well. Advancing Virtual Care CMS is building a stronger focus on remote or virtual care. Proposed changes would add reimbursement
Last week there were some noteworthy cases that came through regarding compliance. This emphasizes the importance of compliance controls in every practice and what each practice needs to do to protect itself. Unlawful Waiving of Co-Pays It often seems like a helpful thing to do for your patients. But did you know that waiving a
