CMS
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Medicare, VHA Made $128M in Duplicate Payments, OIG Report Shows
Medicare could have saved $128 million if the Centers for Medicare and Medicaid Services had the correct controls in place to avoid duplicate payments with the Veterans Health Administration, an audit by the Office of Inspector General found.
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In Rare Move, CMS Fines 2 Hospitals for Price Transparency Violations
CMS recently fined two hospitals for alleged violations of its price transparency rule. These fines are only the third and fourth penalties issued by the agency since the rule took effect on January 1, 2021. These fines may become more common — CMS also announced that it is updating its enforcement process for the rule.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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VBC Won’t Save Safety Net Hospitals, Experts Say
A shift from fee-for-service payment models to value-based models is not an effective way to address the severe financial pressures that safety net hospitals are facing, experts argued at the HIMSS conference in Chicago. One called for a paradigmatic shift “away from cost savings and toward understanding where investments are needed.”
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Advocates of Digital Therapies Hope Bill Can Ease Reimbursement
A similar bill appeared last year but did not progress. Given the potential costs of reimbursing prescription digital therapeutics, Congress could be skeptical. Still, with growing attention on mental health, advocates are optimistic.
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What Gives 3 Execs Comfort and Concern About Medicaid Redeterminations
During a panel at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum, three executives were asked what gives them comfort about the return to Medicaid redeterminations, as well as what worries them. One CMS official said she’s pleased that states are ramping up communication efforts for Medicaid enrollees, but is concerned about the “insurmountable task” ahead.
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Study finds inconsistent data in insurers’ online provider directories
Conducted by researchers at the University of Colorado medical school, the new report is the latest to gauge the extent of a costly problem that federal regulators are working to solve: Information about doctors varies from provider directory to provider directory.
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How CMS, CVS Health Are Tackling Maternal Health Disparities
At the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held last week, two healthcare leaders from the Centers for Medicare and Medicaid Services (CMS) and CVS Health stressed that reducing maternal health disparities is a top priority, with several strategies at play. For CMS, the focus is on encouraging states to extend Medicaid postpartum coverage, while CVS Health is working to leverage doulas in their care delivery.
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AppliedVR Earns First Unique CMS Code Ever Granted to a Digital Therapeutic
CMS recently established a unique code for AppliedVR’s flagship product, marking the first time a digital therapeutic or immersive therapeutic has ever been placed in an existing benefit category. The eight-week program is a physician-prescribed solution that allows patients to manage their chronic lower back pain without opioids from the comfort of their own home.
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Preserve Access to Home Oxygen Therapy Post-Pandemic
CMS should honor its commitment to Medicare beneficiaries, especially those who began home respiratory therapy under the PHE, without requiring them to “restart” the documentation process. Requiring requalification would also be a nightmare for physicians who are already overwhelmed with patient demands.
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Applying Remote Patient Monitoring to Surgery Prep and Recovery, Oncology and Women’s Health
Join us to learn about the latest trends in remote monitoring and how to extend its benefits beyond chronic conditions to more patients – all while using fewer staff resources.
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There Is ‘Skepticism and Support’ for National Provider Directory, CMS Official Says
CMS put out a request for information in October about a CMS-led national provider directory that would allow patients to find and compare providers based on preferences like language and location. Alexandra Mugge, director and deputy chief health informatics officer of the Health Informatics and Interoperability Group at CMS, said there is stakeholder support for the national directory — if it’s executed correctly.
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Pharma, BioPharma, Legal, Payers
HHS Cites 27 Medicare-Covered Drugs Whose Prices Rose Faster Than Inflation
Companies who raised drug prices higher than the rate of inflation must rebate the difference to Medicare, according to a provision of the Inflation Reduction Act. The highest-profile product on the list might be AbbVie’s blockbuster immunology drug Humira.
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CMS Administrator: Telehealth Flexibilities Greatly Expanded Access, But Up To Congress To Extend
During an interview at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held Tuesday in Washington, D.C., CMS Administrator Chiquita Brooks-LaSure discussed CMS’ key focus areas for 2023. This includes the end of the public health emergency, health equity and prescription drug costs.
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Consumer / Employer, Health Tech, Pharma
Medicare Drug Negotiation Is the Model for the Future of Drug Pricing, Abarca CEO Says
For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it’s the latter.
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HHS Aims To Reduce Prescription Drug Costs Through 3 New Models
The U.S. Department of Health & Human Services announced three models Tuesday that will be tested by the CMS Innovation Center and aim to lower prescription drug costs. The models, which include access to $2 generic drugs, build on the Inflation Reduction Act of 2022.
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Insurers Slam CMS for Medicare Advantage RADV Final Rule
The final rule calls for stricter audits on Medicare Advantage plans. AHIP president and CEO Matt Eyles referred to the rule as “unlawful and fatally flawed.”
Promoted
Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
Promoted
Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
