Oct 5, 2021 | Legislation/ Budgets/ Macro
HHS released interim final rules implementing the No Surprises Act. With the publication of these rules, the provisions of the law will be in place for CY 2022 as directed by statute. HHS may undertake additional rule-making but the substance of the new regulatory regime is unlikely to change significantly. Click to read more.
Oct 1, 2021 | Managed Care Friday
1M: Blue Shield California’s community investment to help the California Department of Education expand support for youth mental and behavioral health services within the state’s public school system. California’s Department of Education specifically needs help expanding access to preventive programming, scaling youth mental health training for educators, and creating a statewide Medi-Cal technical assistance guide to help more families access mental and behavioral health services across the state. Papa Does Preach: Maybe Madonna had it wrong after all. A senior companionship company, Papa,...
Sep 28, 2021 | Medicare, Physician Fee Schedule
Medicare FFS reimbursement for top rheumatology codes increased between +2-21% since 2017, rheumatologist compensation is above primary care physician compensation, but below the average across all specialties, and rheumatology drugs could be the target of Part B reform and increased restrictions by commercial payers. Click to read more.
Sep 24, 2021 | Uncategorized
61: Percent of college kids polled by my 17-year-old this past month via his 2,300 Instagram followers who were sick enough in the last 30 days to miss class, take Nyquil, call home, and contemplate whether to go to the clinic given the risk, in their mind, of being quarantined or sent back home. Just 10% who were sick went to the clinic. My son Jack was not one of them, but the upside is he called home… New Uterine Fibroid Treatment Covered: Anthem will begin covering an intrauterine ultrasound system offering treatment for symptomatic uterine fibroids that does not require an incision or...
Sep 21, 2021 | Medicare, Physician Fee Schedule
Recent developments in allergy, ENT, and audiology include mostly positive Medicare FFS reimbursement trends, stable Medicare spending, and increased commercial payer focus on the frequency of allergy testing and high cost specialty drugs administered in the office. Click to read more.
Sep 17, 2021 | Managed Care Friday
24601: Les Miserable fans know this number too well as the mark symbolizing Jean Valjean’s bread stealing moment during the end of the French Revolution, and in a symbolic way this is exactly the number a Medicaid managed care plan’s medical director is advocating the insurer pay per beneficiary per year (well, $24,600 to be exact, but what’s an extra dollar for effect?) to cover housing, health and wellness, transportation, job support and food as part of a social family support concept targeting underserved, typically refugee, populations. Dose E Doh! Several insurers are looking to reduce...
