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CMS proposes new payment model for Medicare Part B Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Tuesday, 05 April 2016 17:32

The Centers for Medicare and Medicaid Services (CMS) is proposing a new rule that could result in a new Medicare Part B drug payment model. Published in the Federal Register, the agency is proposing a two-phase model that would test whether alternative drug payment designs would result in a reduction in Medicare costs, while at the same time preserve, or even enhance, the quality of care for Medicare beneficiaries.

Under the existing methodology, expensive drugs receive higher add-on payment amounts than less expensive drugs, while there are no clear incentives for providing high-value care, including drug therapy. It's hoped that under the new model providers would be incentivized to prescribe the most effective drugs and link payments to patient outcomes.

"We hope that the revised pricing will remove any excess financial incentive to prescribe high cost drugs over lower cost ones when comparable low cost drugs are available," writes CMS. "In other words, we believe that removing the financial incentive that may be associated with higher add-on payments will lead to some reduction in expenditures during phase I of the proposed model."
 
Last Updated on Tuesday, 05 April 2016 17:35
 
Program Integrity Changes to the Medicare Provider Enrollment Process Print E-mail
Written by MWE.com   
Thursday, 17 March 2016 00:00

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled "Medicare, Medicaid, and Children's Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process". The Proposed Rule addresses Medicare, Medicaid and Children's Health Insurance Program (CHIP) enrollment and revalidation reporting requirements, as well as expanded CMS authority intended to increase program integrity through the Medicare enrollment process.  CMS is accepting public comments on the Proposed Rule until May 1, 2016.

In response to concerns that certain providers and suppliers were able to evade federal health care program integrity provisions by changing names or establishing complex entity relationships, the Affordable Care Act incorporated additional requirements in Section 1866(j)(5) of the Social Security Act for disclosure of certain information at enrollment and revalidation intended to identify such relationships before enrolling and making payments to entities that would not otherwise be eligible for enrollment.  The Proposed Rule seeks to implement the requirements of Section 1866(j)(5), as well as provide CMS with additional authority related to denial or revocation of Medicare enrollment and imposition and extension of Medicare reenrollment bars.

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CMS clarifies final overpayment rule: 5 things to know Print E-mail
Written by Laura Dyrda | Becker's ASC Review   
Tuesday, 16 February 2016 10:52
 
Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network, and Other Issues Print E-mail
Written by MWE.com   
Friday, 12 February 2016 19:01

The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The proposed guidance-expected to be issued on February 19-is likely to include substantial proposed changes to the MA risk adjustment methodology and may address increased provider network oversight for MA Organizations (MAOs), among other topics.

Key topics that the Centers for Medicare & Medicaid Services (CMS) is expected to address in the document-known as CY 2017 Advance Notice and Draft Call Letter-include the following...

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Last Updated on Saturday, 05 March 2016 08:34
 
CMS Finalizes Prior Authorization Program for Certain DMEPOS Items Print E-mail
Written by FHI's Week in Review   
Tuesday, 12 January 2016 18:15

In a January 7, 2016 post by MWE.com, the authors report:

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) items frequently subject to unnecessary utilization (the Final Rule). As noted in our commentary on the proposed rule the Final Rule creates a "Master List" of items that could require prior authorization as a condition of Medicare payment as well as a subset list of items for which prior authorization is required. The provisions of the Final Rule are effective on February 29, 2016.

Read more in the current issue of Week in Review>>
 
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