May 5, 2023 | Managed Care Friday
1.7 Million: The number of calls, texts and chats into the national 988 suicide crisis lifeline during the first 5 months of its existence. How the 988 staff deals with these situations and sets up emergency response or makes referrals is still an open question. US Surgeon General Vivek Murthy recently proposed “a national framework to rebuild social connection and community in America” given rising evidence of loneliness and depression in ~60% of young adults and ~50% of mothers with young children according to some studies. Poor Urgent Care: Several insurers are now eliminating copayments...
May 2, 2023 | BRG Publications, Medicare Advantage, Payers
BRG Concludes Partial Dual Eligibles Enrolled In A MA Plan Have Fewer Hospitalizations: Research conducted for Elevance Public Policy Institute finds MA enrollees had more primary care services and few hospitalizations compared to partial dual eligibles enrolled in FFS. Click here to read more.
May 2, 2023 | Hospitals, Inpatient, LTCHs, Medicare
CMS Proposes +2.8% IPPS & +2.9% LTCH Rate Update For FY 2024: CMS has proposed two Medicare policy updates that applies to approximately 3,100 acute care hospitals and 330 long-term care hospital facilities in fiscal year 2024. Click here to read more.
Apr 28, 2023 | Managed Care Friday
70: Percent of this age group lie to their doctor and parents, particularly about their mental health. Any guesses? Imaging Cut: Effective Father’s Day, Blue Cross NC will stop reimbursing for any imaging services – X-ray, CT, or MRI – when billed within 28 days of a principal diagnosis of uncomplicated lower back pain. The health plan is trying to reduce “excessive tests or procedures that result in unnecessary medical expenses.” Consumer Behavior: Dr. House once asked on his TV show, “do I get bonus points if I act like I care?” Short answer is heck yeah. Last we broadly studied what...
Apr 27, 2023 | BRG Conference Call Replays
April 27, 2023 BRG experts John Barkett, Ruth Tabak, and Jessica Dye discuss three notable new regulations related to the Medicare Advantage program. 1. 2024 Medicare Advantage Rate Notice - Lower update for 2024 due to policy changes in the risk adjustment model and other elements of the MA payment system. 2. 2024 Medicare Advantage Policy Rule - Covered topics such as star ratings, marketing and health equity initiatives. 3. RADV Audits - After more than a decade of litigation and attempts at rule-making, CMS has finalized policies for auditing the risk adjustment functions of plans. Click...
Apr 26, 2023 | Medicare, Medicare Advantage, Payers
The Biden administration finalized many policies pertaining to Medicare Advantage (MA) plans, including those related to health equity, utilization management, quality assessment, behavioral health, and other beneficiary protections. Click to read more.
Apr 26, 2023 | Uncategorized
The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: FL: Ending telehealth and other flexibilities for behavioral analysis providers IN: Expanding telehealth originating site facility fee to additional providers OH: House budget includes dental and in-home caregiver rate increases WA: Nursing homes to get a +13.6% Medicaid rate increase Click to read more.
Apr 25, 2023 | BRG Publications
The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the first quarter of 2023, we have taken note of: DOJ/HHS Activity OIG Reports on Epidural Steroid Injection and Spinal Facet-Join Interventions OIG Workplans Three Comparative Billing Reports One Approved RAC Topic One GAO Report OCR Activity Click to read more.
