May 24, 2022 | Behavioral, Medicare, Medicare Advantage
BRG proprietary analysis of 2019 claims data indicates that MA beneficiaries receive fewer mental services and have lower overall spend on these services than FFS enrollees, despite a much higher proportion of mental depressive disorder diagnoses. Click to read more.
May 20, 2022 | Uncategorized
224: The average percent that employers and commercial health plans paid hospitals above Medicare prices, according to a new report by RAND. The report found that hospital prices tended to correlate with hospital market share, which comes as no surprise. Some states, including Florida, West Virginia, and South Carolina, had prices at or above 310% of Medicare. If the same providers were paid Medicare rates for the same services, employers and private plans would have saved almost $50 billion, researchers said. Roe V. Wade Response: Major corporate employers are making headlines this week by...
May 17, 2022 | Behavioral, Medicare, Physician Fee Schedule
Psychiatry & Psychology/Counseling: Recent developments in Psychiatry, Psychology and Counseling include mostly positive Medicare FFS reimbursement trends. Behavioral health needs have increased dramatically in past 2 years due to COVID-19; the space is likely to continue to evolve as need remains high. Click to read more.
May 17, 2022 | Medicare, Physician Fee Schedule, Physicians
Primary Care: Recent developments in Primary Care include generally positive Medicare FFS reimbursement for primary care specialties. Program integrity activity for these specialties remains common. Click to read more.
May 13, 2022 | Managed Care Friday
63: Portion of 316 retired physicians polled who say too many doctors, PAs and nurse practitioners overtest. If you’re looking for a measure of quality, I say take Hamlet’s cue and look at your practice’s testing behavior—to test or not to test is increasingly an important question in healthcare. Most of the retired doctors say we ought to use our personal experience with patients more often—our clinical judgment—as a guide when making decisions about whether to order a clinical lab or imaging to figure out what’s wrong. Too many do not lean on that personal experience enough, and it matters...
May 10, 2022 | Medicare, Medicare Advantage
CMS finalized policy changes to network adequacy standards, dual eligible Special Needs Plans (D-SNPs), negotiated drug price in Part D, consumer information about MA plans, and oversight and transparency measures for third-party marketing organizations (TPMOs). Click to read more.
May 6, 2022 | Managed Care Friday
4,000: The amount Amazon will pay annually for its employees to travel for non-life-threatening medical treatments. The new benefit, effective to January 1 retroactively, applies if a procedure or treatment is not available within 100 miles of an employee’s home and virtual care is not an option. The benefit is open to all US employees, at any level, with coverage through Aetna or Premera. Behaving Differently: More and more insurers are now designating so-called centers of excellence for behavioral health, the latest from BCBS Michigan, which now has 14 substance use treatment and recovery...
