Jan 28, 2021 | Physicians
Recent developments in radiology reimbursement are headlined by E&M reform; payers are focused on shifting site of imaging and moving toward value-based payment arrangements. Click to read more.
Jan 26, 2021 | Medicare Advantage
CMS released the 2022 Medicare Advantage (MA) Rate Announcement on January 15, 2021. The rate updates are estimated to increase MA revenue by +4.08%. In past years, CMS also estimated that risk coding behavior increases MA revenue by an additional +3% to +3.6%. Click to read more.
Jan 22, 2021 | Managed Care Friday
7: The number of additional physician organizations BCBS of Michigan is adding to its risk-sharing payment model, Blueprint for Affordability. In total, 21 organizations are participating, representing roughly 38% of Blue Cross’ total commercial membership and 42% of the Medicare Plus Blue membership. The new physician organizations joining include ACOs and multi-specialty provider groups. Bundle This: A maternity MAT initiative kicks off this month for all OB/GYNs and maternal and fetal medicine doctors in Blue Michigan’s physician performance program, this one focused on addiction....
Jan 19, 2021 | Medicaid, Medicare, MedPAC
This brief summarizes recent activity at MedPAC and MACPAC including: MedPAC: Findings for mandated reports on multiple issues and individual policy briefs on topics ranging from COVID-19 and telehealth to individual payment systems and value-based care. MACPAC: Preliminary findings for the mandated report on Non-Emergency Medical Transportation, Home-and-Community Based Services and mitigating the waiver waitlist, and the 2020 MACStats. Click to read more.
Jan 15, 2021 | Managed Care Friday
3: The amount of free PCP visits Blue Cross NC members will have through a new feature designed to encourage their members to go to the doctor’s office. Effective January 1, 2021, select Blue Cross NC members have no copay for their first 3 visits when visiting their PCP on file. Benefit available to ASO, fully insured, and fully insured individuals under-65 with a copay for office visits. Kidney Care: Beginning this month kidney care management company Somatus launched a pilot to better integrate care for CareFirst BCBS patients with chronic kidney and end-stage renal disease. 250 members...
Jan 12, 2021 | Ambulance, Ground, Medicare
CMS is delaying the nationwide expansion for the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT). CMS will expand the demonstration in the states that have currently implemented the program to review payment efficiency, reduce expenditures, and ensure the right population is covered to receive reasonable services of care. Click to read more.
Jan 8, 2021 | Managed Care Friday
2.2B: The amount Centene is spending to acquire Magellan Health in an effort to strengthen its mental health business. The deal will add 2 million pharmacy benefit members and 16 million medical pharmacy members to Centene's portfolio, the company said. The deal will also bring Centene 18 million third-party customers of specialty health services, which includes physical medicine and rehabilitation to people with disabilities. Acne: “I’m not sure if we’re missing an opportunity to reduce depression, alcoholism, violence and suicide by adding payment incentives to encourage dermatologists to...
Jan 5, 2021 | Legislation/ Budgets/ Macro
Periodically, the Congressional Budget Office (CBO) publishes options for deficit reduction. This brief highlights the latest compendium, which the CBO released in December 2020. Click to read more.
