- About Us
- Contact Us
This afternoon, CMS released amounts for hospital and physician services deductibles and cost-sharing for Medicare beneficiaries for 2018:
Inpatient Hospital Deductible: $1,340 (+$24 from 2017) Inpatient Hospital Daily Coinsurance: $335 (Days 61-90) (+$6/day from 2017) $670 (lifetime reserve days) (+$12/day from 2017) Extended Care Services in a Skilled Nursing Facility: $167.50 (Days 21-100) (+$3/day from […]
This evening, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program. Included within this rule are proposed changes to the Medicare Advantage program. Some of […]
For the first time in three years, CMS has proposed a formal regulation concerning the Medicare Advantage (MA) and Medicare Part D prescription drug benefit programs. Typically, the agency has managed both benefits via the annual Call Letter process, which is subregulatory guidance. The proposed rule garnered a lot of speculation while it was […]
On Saturday, November 11, 2017, the Light the Trail cycling team completed a 3,700 mile pedal across the country. Light the Trail leaders Isaac Manning and Tom Harris started on their bikes in Oregon on September 1st and 72 days later arrived at the Jefferson Memorial in Washington, DC, all in an effort to shed light on, and […]
The Centers for Medicare & Medicaid Services (CMS) has released its much-anticipated Calendar Year (CY) 2018 Quality Payment Program (QPP) Final Rule. In this final rule, CMS details changes to both the Advanced Alternative Payment Models (APMs) track and the Merit-Based Incentives Payment System (MIPS) track of the QPP.
CMS says it expects this program […]
On November 2-3, 2017, the Medicare Payment Advisory Commission (MedPAC) held a public meeting covering a variety of topics. Much of the discussion focused on an alternative to the Merit-based Incentive Payment System (MIPS), telehealth services, and biosimilars.
Continuing the discussion began at the previous public meeting, the Commission considered a possible alternative to […]
Tonight, CMS released the final Medicare Physician Fee Schedule (MPFS) payment rule for 2018. CMS is finalizing an overall update to physician payments of +0.41%, and the 2018 conversion factor will increase by $0.10, to $35.99 from 2017’s $35.89. Read on for more news….
Coding Policy Change for Biosimilars
In 2016, CMS finalized a […]
In what is likely the first major Medicare policy change of the Trump Administration, Medicare payment for 340B drugs administered in the hospital outpatient department will be cut from 106% of average sales price (ASP, or ASP+6%) to average sales price less 22% (ASP-22%). Those who have been following President Trump’s statements on health care […]
This evening, CMS also released the CY 2018 Home Health Prospective Payment System (HH PPS) Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements final rule which will be effective on January 1, 2018. Within this rule, CMS announces an overall payment adjustment of […]
Last Friday evening, the Department of Health and Human Services (HHS) released the proposed requirements for qualified health plans (QHPs) in 2019. QHPs are those health plans offered on the individual and small-group markets, both on and off the Marketplaces (or Exchanges). Many of the proposals were familiar, such as delegating more authority and […]