HIS’ Post

The Centers for Medicare & Medicaid Services (CMS) released draft guidelines of how it will approach the IRA for the medicines to be price-controlled in 2027, and the agency’s suggested rules raise more questions than they answer. CMS is still refusing to demand that PBMs ensure that savings are passed to patients, and plans for the administrative structure that will hold the whole program together financially – the Medicare Transaction Facilitator – still remain dangerously underdeveloped. Read more on their draft guidance here: https://lnkd.in/egmbvyb2

On June 28, the Centers for Medicare & Medicaid Services (CMS) announced a Proposed Rule titled Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023 (CMS-1799-P). While CMS touts this rule as a step forward in addressing billing abuses within the Medicare Shared Savings Program, it raises questions about the agency’s historical efficacy and commitment to combating fraud. The Shared Savings Program is designed to promote accountability for the healthcare of Medicare beneficiaries and encourage efficient service delivery. However, recent trends in billing activities, specifically concerning durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), have prompted concerns about the integrity of financial calculations. In the 2023 calendar year (CY), CMS observed a spike in billing for specific intermittent urinary catheter supplies, identified by HCPCS codes A4352 and A4353. This surge in billing could, if not addressed, distort the accuracy of expenditure and revenue calculations critical to the program.

On 3 May, the Centers for Medicare & Medicaid Services issued draft guidance for initial price applicability year 2027 of the Drug Price Negotiation Program established by the IRA. Read our insights here. https://lnkd.in/ehBqZyN9 #IRA #drugpricing

Project 2025 proposes significant changes to Medicare and Medicaid that will adversely affect seniors: ■ Medicare Changes: The plan aims to eliminate traditional Medicare, pushing seniors towards Medicare Advantage plans, which are managed by private insurers. This shift could limit seniors' access to healthcare providers and increase out-of-pocket costs due to restrictive networks and coverage limitations. ■ Prescription Drug Costs: By repealing the Inflation Reduction Act, Project 2025 would stop Medicare from negotiating drug prices, potentially raising prescription costs for at least 18 million seniors. ■ Medicaid Adjustments: The proposal includes allowing states to reduce Medicaid coverage, particularly for nursing home care, which could severely impact seniors relying on Medicaid for long-term care. ~https://lnkd.in/e-3Wwm_b, afscme.org

Centers for Medicare & Medicaid Service Notices Publication Date: 4/23/2024 Comments Close: 5/23/2024 Agency Information Collection Activities; Proposals, Submissions, and Approvals Medicaid and CHIP Program (MACPro) FedRegDoc#:2024-08658 FRDoc@89 FR 30377 (3 pgs) Agency/Document Identifier: CMS-10434 At this time, MACPro is made up of the main umbrella (see collection number 1 in the following list) and nine individual generic collections of information (see collection numbers 2 through 10 in the following list). Details such as the collection's requirements and burden estimates can be found in the collection's supporting statement and associated materials (see ADDRESSES for instructions for obtaining such documents). William N. Parham, III Director, Division of Information Collections and Regulatory Impacts, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2024-08658 Filed 4-22-24; 8:45 am] https://lnkd.in/e6_BuZe8

Docs Speak Out: Medicare Reimbursement Woes What are physicians' biggest business challenges with accepting Medicare and Medicaid? “Be considerate of our time. Your Medicaid program pays low fees. Do not put our staff through the grinder,” shared one doc. Discover more insights in the Medscape Doctors Evaluate Medicare and Medicaid Report 2024. https://lnkd.in/eJwie7XU

🏆 All About MVPs 🏆 Since the 2023 Performance Year (PY23), Centers for Medicare & Medicaid Services has implemented a new reporting option for the Merit-Based Incentive Payment System (MIPS) called MIPS Value Pathways (MVPs). Currently, MVPs are optional for eligible clinicians to report, but will become mandatory in years to come. In our latest blog post, we break down: 🔸 What MVPs are and what they offer clinicians 🔸 Why you should begin your transition now and 🔸 Your participation options Learn about MVPs for 2024: https://lnkd.in/gnkaTDTX

The Centers for Medicare & Medicaid Services (CMS) has released participation and performance data for the 2022 performance year of the Quality Payment Program (QPP), including both Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) participation. Of significant note, the data shows that the 5% incentive payment under The Medicare Access and CHIP Reauthorization Act (MACRA) successfully incentivized the adoption of advanced alternative payment models. CMS’s report shows that the number of clinicians who participated in an advanced APM from 2021 to 2022 increased by 26% to more than 420,000 clinicians. A4H continues to work with Congress to enact strong, clear incentives for the adoption of advanced alternative payment models.

The Centers for Medicare & Medicaid Services (CMS) have announced a proposed rule titled “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023” (CMS-1799-P). SAHS billing activity is defined by significant, unexplained increases in claims volume or dollars that deviate from historical trends. The proposed rule aims to counteract such activities by excluding payments for the identified HCPCS codes from various financial calculations. The Shared Savings Program is designed to promote accountability for the healthcare of Medicare beneficiaries and encourage efficient service delivery. However, recent trends in billing activities, specifically concerning Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS), have prompted concerns about the integrity of financial calculations. In CY 2023, CMS observed a spike in billing for specific intermittent urinary catheter supplies, identified by HCPCS codes A4352 and A4353. This surge in billing could, if not addressed, distort the accuracy of expenditure and revenue calculations critical to the program

Although the Centers for Medicare & Medicaid Services (CMS) made changes to their Merit-based Incentive Payment System (MIPS) at the beginning of this year, there’s still time for you to set yourself up to get the most value out of your 2024 performance. Join us for a live webinar today as we walk through what changed this year, discuss your reporting options, and explore ways you can help your practice prepare to report MIPS successfully. https://lnkd.in/gpnYqNjN #healthcare #business