Oct 22, 2021 | Managed Care Friday
850: Pacific Dental Services, the Irvine, CA based dental service organization, hasn’t just opened its 850th dental practice but it has launched a dental-medical practice with the opening of 3 practices - general dentistry, pediatric dentistry, and medical care - all in one Nevada location. All Bets Off Kenny Rogers: More payers are covering therapy for gamblers but not in every setting and not as restrictive as you might think. Excellus BCBS allows OP therapy for gamblers without pre-approval. Residential, partial hospitalization and inpatient services are thought to be investigational. ACT...
Oct 19, 2021 | Medicare, Physician Fee Schedule
After increases due to E&M changes, Medicare FFS reimbursement for urology is likely stable. Additionally, CMS is proposing to update pricing of the clinical labor element of practice expenses, which will likely be implemented through a phased-in approach. Click to read more.
Oct 15, 2021 | Legislation/ Budgets/ Macro
Congress continues to negotiate the details of a reconciliation bill, including several health provisions that affect drug pricing, Medicare Advantage, Exchange plans, Medicaid coverage, and home- and community-based care. Click to read more.
Oct 15, 2021 | Managed Care Friday
76: Percent of high school seniors polled here in my home town this past week who are reportedly going to pursue a career in nursing. Homeward Bound: SCAN Health Plan is offering a new type of plan for members who are homebound or reside in SNFs or assisted living, called the Embrace plan. The plan, an Institutional Special Needs plan for MA enrollees, will focus on allowing these members to remain in their homes or facilities while receiving care that would typically be provided in a doctor’s office or hospital. Enrollment in Embrace for calendar year 2022 begins on October 15, 2021....
Oct 12, 2021 | Legislation/ Budgets/ Macro
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 third quarter of 2021, we have taken particular note of: DOJ/HHS activity OIG Medicare Advantage Company Review Three Comparative Billing Reports Two GAO reports OCR activity Approved and proposed additions to the RAC audit list Click to read more.
Oct 8, 2021 | Managed Care Friday
112M: The cost savings BCBS of NC experienced through its partnership with laboratory benefit manager, Avalon Healthcare Solutions. Since initiating the partnership in 2017, Avalon helped move more lab services in-network and implemented pre-approval to ensure tests were medically necessary. There’s a growing focus on the “clinical utility” of lab tests. In 2020, 99% of all lab services were provided within BCBS NC’s network, compared to 86% in 2017. Good Genes: Beginning January 2022, BCBS Michigan will begin allowing genetic counselors to join their network and receive direct...
Oct 7, 2021 | Medicare, Medicare Advantage
The 2010 Affordable Care Act (ACA) reshaped payments to MA plans, including reducing government spend relative to pre-ACA levels. Despite these cuts, MA plan enrollment has grown, monthly premiums have declined, more plans offer $0 premium options, and supplemental benefits continue to expand. Current Congressional discussions of MA payment changes are much more modest relative to ACA changes. Click to read more.
