On July 13th, the Centers for Medicare & Medicaid Services (CMS) issued the Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule, which…
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In our series on prior authorizations, we have previously considered the administrative burden prior authorizations present for healthcare providers, as well as their potential to delay definitive care for…
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On June 22, 2023, Centers for Medicare & Medicaid Services (CMS) released the highly anticipated proposed Medicare device coverage pathway for breakthrough medical devices, known as Transitional Coverage…
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As the Centers for Medicare & Medicaid Services (CMS) has contracted with private health insurance plans for the provision of managed care options under the Medicare Advantage (MA)…
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The American Academy of Professional Coders (AAPC) held its highly anticipated national conference, HEALTHCON 2023, in Nashville, Tennessee, May 22-24. The event attracted a wide range of professionals…
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Step therapy is the process under which a health insurance plan requires a patient to try one or more alternative—typically lower cost— drugs or treatment options before they…
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As noted last month, prior authorizations can be an important means of identifying clinically inappropriate or duplicative care. They are also increasingly employed as gatekeeping mechanisms to control…
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Applied Policy has previously reported on the work of Recovery Audit Contractors (RACs), independent contractors sometimes characterized as “bounty hunters” for their pursuit of improper payments in the…
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On April 25, the Centers for Medicare & Medicaid Services (CMS) hosted an office hours session to help providers, facilities, and Medicare beneficiaries prepare for the end of…
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On April 26-27, the Medical Device Manufacturers Association (MDMA) held their Annual Meeting to discuss topics impacting medical device manufacturers. Food and Drug Administration (FDA) representatives, Centers for…
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On April 17, 2023, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit…
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As an appreciation for the impact of social determinants of health moves from academia to practical applications, many healthcare providers, payers, and policymakers are exploring the potential of…
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