Archive for the Financial Feature Category

CMS Issues Proposed Rule to Lower Drug Costs

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would amend Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations “to support health and drug plans’ negotiation for lower drug prices and reduce

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Final Rule for CY 2019 Hospital Outpatient and ASC Prospective Payment Systems

The Centers for Medicare and Medicaid Services (CMS) have issued a rule that updates payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and in ambulatory surgical centers (ASCs) beginning Jan. 1, 2019 (CY 2019). The

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CMS Finalizes CY 2019 Revisions to Physician Fee Schedule

CMS has issued a final rule that includes update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2019 (CY 2019). The 2019 physician fee schedule conversion factor is $36.04, which

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CMS Finalizes CY 2019 End-Stage Renal Disease PPS Update

CMS has issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for services furnished on or after Jan. 1, 2019 (CY 2019). This rule updates the acute kidney injury (AKI) dialysis payment rate for

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CMS Finalizes Calendar Year 2019 Payments and 2020 Policy Changes for Home Health Agencies and Home Infusion Therapy Suppliers

CMS issued a final calendar year 2019 update to the home health prospective payment system (HH PPS). The rule will update both the payment rates and case-mix weights for home health agencies (HHAs) for CY 2019. For home health services beginning on or after

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CMS Proposes Select Calendar Year 2020 Medicare Advantage and Part D Changes

CMS issued a proposed rule that would revise certain aspects of the Medicare Advantage (MA) program (Part C), the Prescription Drug Benefit program (Part D); implement certain provisions of the Bipartisan Budget Act of 2018; improve quality and accessibility; clarify certain program integrity

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CMS Proposes International Pricing Index Model for Medicare Part B Drugs

CMS has issued an Advance Notice of proposed rulemaking regarding the development of a potential model that seeks payment prices comparable for Part B drugs relative to other economically-similar countries. CMS says that a proposed rule would be issued, based on comments, in the spring

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2019 Medicare Parts A & B Premiums and Deductibles

The Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, an increase of $1.50 from

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CMS Proposes to Require Manufacturers to Disclose Drug Prices in Television Ads

CMS has released a proposed rule that is intended to reduce the price to consumers of prescription drugs and biological products. This rule would require direct-to-consumer (DTC) television advertisements for prescription drug and biological products for which reimbursement is available, directly or indirectly, through

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CMS Announces Participants in New Value-Based Bundled Payment Model

The Centers for Medicare and Medicaid Services’ Innovation Center has announced a new voluntary episode payment model, Bundled Payments for Care Improvement Advanced, that will test a new iteration of bundled payments for 32 Clinical Episodes and aims to align incentives among participating healthcare

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