Nov 13, 2019 | ESRD, Medicare
CMS has finalized a payment update of +1.7% to the ESRD PPS, with limited adjustments from the proposed rulemaking. Click to read more.
Nov 12, 2019 | Drugs, Medicare, Physician Fee Schedule, Physicians
CMS finalized changes to new Medicare coverage of substance use disorder services under the physician fee schedule, including medication-assisted therapies for opioid treatment, starting January 2020. CMS made changes to the original proposal, including substantially increasing rates for opioid treatment providers. Click to read more.
Nov 11, 2019 | Hospitals, Inpatient, Medicare
Just over half of hospitals will receive payment increases under Medicare’s hospital value-based purchasing initiative, CMS recently announced. All hospitals have 2% of payments withheld – or nearly $1.9 billion total – which is returned to hospitals based on quality achievements and improvement scores. Click to read more.
Nov 8, 2019 | Managed Care Friday
1. 174 of 221: Middle schools in our poll this week who said they hoped to add psych and mental health programming and staff into their 2020 offering, including experimentations with telepsych in some districts and partnerships with local mental health groups, but have ‘struggled to staff and recruit’ due to a shortage. Only 86 of the 174 say they filled their slots and started programming. 2. Extenders Win: In an effort to increase access to healthcare, Anthem Virginia now contracts directly with NPs and PAs for its Medicaid beneficiaries under new state regulations that took effect...
Nov 7, 2019 | Medicare, Physician Fee Schedule
CMS has finalized the 2020 update to the Medicare physician fee schedule (PFS). In general, the rule finalizes many of the changes included in the proposed rule, including a major restructuring of E/M codes. This brief provides highlights of the final rule. Click to read more.
Nov 6, 2019 | Behavioral, Home Health, Medicare
CMS finalized rates and policies for implementation of the Patient-Driven Groupings Model for Medicare home health, beginning on January 1, 2020. After significant industry pushback, the agency halved the reduction to rates it was making to account for provider behavioral responses to the new payment system, as required by Congress. Click to read more
Nov 5, 2019 | Medicare, Medicare Advantage, Part D
CMS released Star Ratings for 2020 Medicare Advantage and Part D prescription drug plans, expecting that approximately 81% of Medicare Advantage enrollees with prescription drug coverage will enroll in plans with at least 4 stars. Click to read more.
Nov 1, 2019 | Managed Care Friday
110: The number of nurses Blue Carolina is using through its new Health Blue Line to help members facing a serious medical event or chronic condition. Initial calls can last between 30 to 60 minutes, with follow-up calls lasting around 15 minutes. Through an integrated care management program officially launching in January 2020, nurses will refer patients to outpatient services, community resources, and PCPs as needed, including for behavioral health help. Telehealth Momentum: Despite last week’s study revealing senior dislike for tele-encounters, Intermountain Health System has launched a...
Oct 30, 2019 | Physician Fee Schedule
Around November 1, CMS will release the annual Physician Fee Schedule (PFS) final rule which will set physician payment rates for the year 2020. How rates are set involves dozens of adjustments – even for codes that don’t undergo any specific review. This review looks at some of the basics of how rates are set and adjusted each year under the PFS. Click to read more
Oct 29, 2019 | Legislation/ Budgets/ Macro
In an era when HHS has been pushing for more provider care coordination through ACOs and other policies, the Stark self referral laws and the anti-kickback statutes have increasingly come to be seen as outdated and in need of greater flexibility. After soliciting input this past year through a request for public input (RFI), OIG recently put forward a formal proposed rule expanding exceptions to those laws under certain circumstances. Click to read more.
