Blog Archive

CMS Releases Proposed Hospital Outpatient and Ambulatory Surgical Center Update for CY 2024, Establishing Payment for Intensive Outpatient Programs, with Changes to Price Transparency (CMS-1786-P)

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On July 13th, the Centers for Medicare & Medicaid Services (CMS) issued the Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems…

Prior Authorizations and Health Equity

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

CMS publishes long-awaited proposed pathway for Medicare coverage of emerging technologies

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On June 22, 2023, Centers for Medicare & Medicaid Services (CMS) released the highly anticipated proposed Medicare device coverage pathway for breakthrough medical devices, known…

Prior authorizations in Medicare Advantage

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] As the Centers for Medicare & Medicaid Services (CMS) has contracted with private health insurance plans for the provision of managed care options under the…

AAPC’s HEALTHCON 2023

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

The Debate over Step Therapy

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

Prior authorizations and the U.S. healthcare system

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

Unified Program Integrity Contractors

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

CMS Holds Office Hours on the End of the Public Health Emergency

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On April 25, the Centers for Medicare & Medicaid Services (CMS) hosted an office hours session to help providers, facilities, and Medicare beneficiaries prepare for…

MDMA Holds 2023 Annual Meeting

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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)…

CMS Releases Final Rule for 2024 Qualified Health Plans, Strengthening Network Adequacy Standards, and Expanding Consumer Access

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

The Growing Food as Medicine Movement

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

impact your business