Jul 26, 2021 | Medicare, Payers, Physician Fee Schedule
Pathology: Recent developments in pathology include increases in Medicare FFS spending and reimbursement, as well as a focus on controlling clinical lab utilization and spending by commercial and MA plans through prior authorization requirements. Click to read more.
Jul 26, 2021 | Medicare, Payers, Physician Fee Schedule
Oncology: Recent developments in oncology include stability in Medicare spending, mostly positive FFS reimbursement trends, and innovative payment models by both CMS and commercial payers. Click to read more.
Jul 23, 2021 | Managed Care Friday
517,000: Cost of medical and pharmacy claims for a small cohort of caregivers one health plan utilization analyst studied this year. The patients “take care of sick relatives, then they get sick from the stress.” The analyst said she’s providing a report to the medical and product design teams in the fall with “stats and case examples” like the 57-year-old who had zero claims cost for the prior 5 years outside of check-ups then a 3-year uptick that led to a heart attack” One idea she’s going to float is a division of labor system that “weans” hours, gradually taking the caregiver “from the...
Jul 20, 2021 | ESRD, Home Care, Home Health, Physician Fee Schedule
ESRD: CMS has proposed a +1.0% increase to the End-Stage Renal Disease (ESRD) base rate for CY 2022, and changes to the ESRD Treatment Choices (ETC) Model to continue to promote the use of home dialysis while addressing socioeconomic disparities between patients. Click to read more. Home Health: For CY 2022, CMS estimates a +1.7% update to home health payments, resulting in an estimated $310 million payment increase. This reflects a +1.8% proposed increase and -0.1% decrease in payments due to reduction in the rural add-on payment. Click to read more.
