Nov 6, 2019 | Behavioral, Home Health, Medicare
CMS finalized rates and policies for implementation of the Patient-Driven Groupings Model for Medicare home health, beginning on January 1, 2020. After significant industry pushback, the agency halved the reduction to rates it was making to account for provider behavioral responses to the new payment system, as required by Congress. Click to read more
Nov 5, 2019 | Medicare, Medicare Advantage, Part D
CMS released Star Ratings for 2020 Medicare Advantage and Part D prescription drug plans, expecting that approximately 81% of Medicare Advantage enrollees with prescription drug coverage will enroll in plans with at least 4 stars. Click to read more.
Nov 1, 2019 | Managed Care Friday
110: The number of nurses Blue Carolina is using through its new Health Blue Line to help members facing a serious medical event or chronic condition. Initial calls can last between 30 to 60 minutes, with follow-up calls lasting around 15 minutes. Through an integrated care management program officially launching in January 2020, nurses will refer patients to outpatient services, community resources, and PCPs as needed, including for behavioral health help. Telehealth Momentum: Despite last week’s study revealing senior dislike for tele-encounters, Intermountain Health System has launched a...
Oct 30, 2019 | Physician Fee Schedule
Around November 1, CMS will release the annual Physician Fee Schedule (PFS) final rule which will set physician payment rates for the year 2020. How rates are set involves dozens of adjustments – even for codes that don’t undergo any specific review. This review looks at some of the basics of how rates are set and adjusted each year under the PFS. Click to read more
Oct 29, 2019 | Legislation/ Budgets/ Macro
In an era when HHS has been pushing for more provider care coordination through ACOs and other policies, the Stark self referral laws and the anti-kickback statutes have increasingly come to be seen as outdated and in need of greater flexibility. After soliciting input this past year through a request for public input (RFI), OIG recently put forward a formal proposed rule expanding exceptions to those laws under certain circumstances. Click to read more.
