Aug 3, 2021 | ASC, Hospitals, Outpatient
HOPPS/ASC: For 2022, CMS has proposed a +2.3% rate update to the hospital outpatient prospective payment system (HOPPS) and the ambulatory surgical center (ASC) payment system. Click to read more. You can also view our July Monthly Snapshot here.
Aug 3, 2021 | Physician Fee Schedule
Physician Fee Schedule (PFS): CMS has published the proposed PFS Rule for CY 2022. After accepting public comment on the rule, CMS will publish a final rule around November 1, 2021 with an effective date of January 1, 2022. Click to read more. Join BRG expert John Kelliher to discuss the 2022 PFS proposed rule on Friday, August 6th at 1PM EST. Please register here in advance of the call. Following registration, you will receive a confirmation email with dial-in information.
Jul 30, 2021 | Legislation/ Budgets/ Macro, Medicare
BRG Managing Director, Misha Segal, co-authors a Health Affairs’ blog exploring the history and evolution of Medicare payment reform and growth in alternative payment models (APMs), including the Medicare Shared Savings Program (MSSP). It also highlights advanced APMs (A-APMs), such as risk-bearing ACOs, and the policy decisions impacting incentives that have limited provider adoption of these risk models. Segal and his co-authors provide potential federal policy solutions to improve participation and success in these risk-bearing models and illustrate what the future could hold for A-APMs...
Jul 30, 2021 | Managed Care Friday
$140M: The amount Anthem and Humana are investing in a new pharmacy benefit manager. With this investment, the plans will hold a minority stake in the new company, DomaniRx. SS&C Technologies, a fintech company, will own the other 80%. Humana will be the PBM’s first customer, as the company “aims to offer payers more transparency into their drug costs and help them better comply with changing government regulations” according to a press release. Did You Hear About The Detox Fix? A noninvasive treatment to manage opioid withdrawal symptoms recently hit the market. S.T. Genesis looks like...
Jul 29, 2021 | Legislation/ Budgets/ Macro, Revenue Cycle
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 second quarter of 2021, we have taken particular note of: DOJ/HHS activity OIG semiannual report Four Comparative Billing Reports Three GAO reports OCR activity Approved and proposed additions to the RAC audit list Click to read more.
Jul 26, 2021 | Medicare, Payers, Physician Fee Schedule
Pathology: Recent developments in pathology include increases in Medicare FFS spending and reimbursement, as well as a focus on controlling clinical lab utilization and spending by commercial and MA plans through prior authorization requirements. Click to read more.
Jul 26, 2021 | Medicare, Payers, Physician Fee Schedule
Oncology: Recent developments in oncology include stability in Medicare spending, mostly positive FFS reimbursement trends, and innovative payment models by both CMS and commercial payers. Click to read more.
Jul 23, 2021 | Managed Care Friday
517,000: Cost of medical and pharmacy claims for a small cohort of caregivers one health plan utilization analyst studied this year. The patients “take care of sick relatives, then they get sick from the stress.” The analyst said she’s providing a report to the medical and product design teams in the fall with “stats and case examples” like the 57-year-old who had zero claims cost for the prior 5 years outside of check-ups then a 3-year uptick that led to a heart attack” One idea she’s going to float is a division of labor system that “weans” hours, gradually taking the caregiver “from the...
