Aug 5, 2019 | ASC, Hospitals, Imaging, Medicare, Outpatient, Physician Fee Schedule
CMS has released a Congressionally-mandated proposal to revamp Medicare FFS payments for radiation treatment. This brief provides a summary of the proposal. Click to read more
Aug 2, 2019 | Managed Care Friday
1. 59: Percent of school teachers and administrators in our poll of 1,306 last month who say 2 of their top 3 challenges they need help addressing in the next school year are health related—autism and mental health. 2. Jet Blues: The airline operator now will give its employees access to psychologists and psychiatrists 7 days a week at $20 a session. 3. Pre Approval Coming: BCBS of Texas will require pre approval starting at the end of August for genetic testing and sleep studies. Evicore will handle the decisions. 4. Lung Outcomes: Kramer took dog pills to treat his chronic respiratory...
Aug 2, 2019 | Medicare, Physician Fee Schedule, Physicians
In the recently released 2020 proposed update to the Medicare Physician Fee Schedule, CMS proposes another major revamp of evaluation and management office visit (E/M) codes following last year’s final rule. While the AMA-developed proposal would result in big payment increases and simplification of billing for E/M codes, offsetting those increases would result in big cuts to some physician specialties that don’t bill E/M codes or have their own E/M-type codes. Click to read more.
Jul 31, 2019 | Legislation/ Budgets/ Macro
On July 25, the Senate Finance Committee marked up a draft bill addressing drug pricing and discussed various amendments from Committee members. The Committee voted to report out the bill to the full Senate, and it must be reconciled with House legislation which is not scheduled to be released until September, before a final vote. Click to read more.
Jul 30, 2019 | Medicare, Medicare Advantage, MedPAC
In its summer report to Congress, MedPAC discussed redesigning the quality bonus program for Medicare Advantage (MA) plans, also known as the star bonus program. This brief discusses key highlights from the chapter. Click to read more.
Jul 29, 2019 | Legislation/ Budgets/ Macro
Presidential candidate Joe Biden released his healthcare plan that expands on the Affordable Care Act (ACA) enacted in 2010. Biden’s proposal is less extensive than other plans by Democratic presidential candidates, but is also more realistic in terms of its ability to be enacted, even if partially, in a divided Congress. Click to read more.
Jul 26, 2019 | Managed Care Friday
1. New MA Plan 2020: Montifiore Health System and Oscar Health will create a joint Medicare Advantage plan in NYC starting in 2020 featuring individual and small groups plans for New Yorkers. It will be interesting to see two things – adoption of the plan as well as how well these models fare on a total cost of care basis vs. purely independent providers. 2. NW Blue Inks Deal With TalkSpace: Premara, the Blue plan in the upper northwest, wins in early votes as among the most favorable insurers for behavioral health. Case in point, it just signed a contract with the virtual counseling service...
Jul 25, 2019 | Drugs, Medicare, Part D
The Department of Health and Human Services (HHS) has announced it will no longer move forward with the rule that would have prohibited the payment of certain rebates in Medicare Part D. Click to read more.
Jul 24, 2019 | Legislation/ Budgets/ Macro
The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. This brief highlights a recent CBO report that provides estimates for the 2019–2029 period of the number of non-institutionalized civilians under age 65 with health insurance, and the federal costs associated with each kind of insurance subsidy. Click to read more.
Jul 24, 2019 | Home Health, Home Infusion, Medicare
CMS proposed a 1.3% CY 2020 rate update to home health payments. The proposal is similar to the rule from November 2018, which finalized the PDGM payment model for 2020, and included home infusion measures. Click to read more.
