Medicare

MedPAC to Talk Telemedicine, Doc Payments, 340B, More

Members of the Medicare Payment Advisory Commission will meet publicly on Thursday, April 11 and Friday, April 12. Medicare reimbursement subjects on the two-day session’s agenda include: telehealth inpatient rehabilitation hospital payments the physician fee schedule Medicare Advantage Part D generic drug pricing Part B rate and 340B ceilings Go here for a more detailed look at the MedPAC agenda and for information about how to participate in the meeting.

MedPAC Meets

Members of the Medicare Payment Advisory Commission met publicly last week in Washington, D.C.  Their agenda consisted of the following issues: Rural hospital and clinician payment policy: A workplan for 2024–2025 Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources Preliminary analysis of Medicare Advantage quality Medicare’s Acute Hospital Care at Home program Update on trends and issues in Medicare inpatient psychiatric services Go here for a brief overview of each agenda item and links to the staff presentations on those issues and here for a transcript of the two-day meeting. MedPAC [...]

2024-03-13T16:10:33+00:00March 14, 2024|Medicare, Medicare reimbursement policy, MedPAC|

CMS Clarifies Medicare Advantage Rule

To help clarify its final Medicare Advantage rule for 2024, the Centers for Medicare & Medicaid Services has published an FAQ providing additional guidance to Medicare Advantage plans and Medicare-Medicaid plans about prior authorization for admission to post-acute-care facilities and plans’ future use of artificial intelligence (AI), algorithms, and other software tools in their coverage criteria and utilization management practices. The rule has broad implications for most health care providers but especially for post-acute-care providers, which the FAQ reflects by addressing major issues and long-running challenges for such providers, including prior authorization for discharge from acute-care hospitals into post-acute care, [...]

Acute Hospital Care at Home Shows Promise

The Acute Hospital Care at Home program, launched by the Centers for Medicare & Medicaid Services during the COVID-19 pandemic to free hospital beds for COVID and other sick patients, is showing promise as an alternative to hospital care for at least some patients. In an analysis of more than 5000 Medicare patients participating in the Acute Hospital Care at Home program from mid-2022 through mid-2023, only 0.5 percent of participants passed away while being served by the program at home and only 6.2 percent required a return to a hospital for more than 24 hours. With the waiver enacted [...]

2024-01-16T14:21:27+00:00January 17, 2024|Centers for Medicare & Medicaid Services, Medicare|

Medicare Underpayment of Hospitals Continues

Medicare paid hospitals only 82 percent of what they spent caring for Medicare patients in 2022, according to a new analysis. That amounted to a Medicare payment shortfall of nearly $100 billion. Learn more about these numbers, how they were calculated, and what they mean for hospitals and their Medicare patients from the American Hospital Association report “Medicare Significantly Underpays Hospitals for Cost of Patient Care.”

2024-01-11T19:41:33+00:00January 15, 2024|hospitals, Medicare|

Expanded Mental Health Options Coming to Medicare

Beginning on January 1, Medicare beneficiaries will have access to more varied types of mental health services. At that time, mental health counselors and marriage and family therapists will become eligible to accept Medicare payments, joining the limited number of psychiatrists, psychologists, and social workers who have been serving the Medicare population as part of the first expansion of Medicare-eligible mental health providers since 1989. With Medicare planning to pay its new provider types 75 percent of what it pays psychologists, it is not clear how many of those new providers will be interested in enrolling as eligible Medicare providers.  [...]

2023-12-21T15:22:53+00:00December 26, 2023|Medicare, Medicare reimbursement policy|

Federal Health Policy Update for December 7

The following is the latest health policy news from the federal government for December 1-7.  Some of the language used below is taken directly from government documents. Congress While Congress has more than a month before the next federal funding deadline of January 19, committees are working to prepare and pass health care legislation. On the House calendar for floor votes next week is H.R. 5378, the Lower Costs, More Transparency Act.  This bill would eliminate the pending cuts to Medicaid DSH for two years (those cuts are temporarily suspended through January 19); introduce site-neutral payments for drug administration services [...]

Medicare Leaving Gaps in Care

Medicare is leaving large numbers of the program’s beneficiaries without at least some of the care they need. According to the Commonwealth Fund’s annual health care affordability survey, One-third of Medicare beneficiaries said it was difficult to afford health care costs, including more than half of beneficiaries under age 65. More than one in five beneficiaries reported delaying or skipping needed health care because of the cost, including more than four in 10 under age 65. More than one in five beneficiaries said health care costs made it harder for them to afford food and utility bills, including more than [...]

2023-11-02T06:00:32+00:00November 2, 2023|Medicare|

Telehealth Serving Some Medicare Patients Well

Medicare patients with serious mental health problems were well-served through telehealth during the COVID-19 crisis. According to a new study published by the JAMA Network, such patients experienced … 13.0% more mental health visits than those receiving care at practices that largely used in-person visits.  There were no changes in medication adherence, hospital and emergency department use, or mortality based on the extent of telemental health use. The study’s findings support continued use of telehealth for Medicare patients with mental health problems even now that the greatest threat of the pandemic has passed. Learn more about how the study was [...]

2023-11-01T13:00:57+00:00November 1, 2023|Medicare, Telehealth|

Federal Health Policy Update for August 24

The following is the latest health policy news from the federal government for August 11-24.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services After suspending the No Surprises Act-created Independent Dispute Resolution process in the wake of a court ruling striking down a recent increase in fees for that process, CMS has established a new rate structure for initiating the adjudication of payment disagreements between providers and payers.  It explains the new rate structure in this new FAQ, which nevertheless notes that despite the creation of new rates, the Independent [...]

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