Archive for: Medicare

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Payment Innovation: Other

CMS Releases Procedure Price Look-Up Tool for Services Performed in the OPPS and the ASC

CMS launches new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.

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Payment Innovation: Other

FY 2019 HVBP Results Released: Most Hospitals Will See Modest Adjustments to their IPPS Payments

CMS released FY 2019 results from the Hospital Value Based Purchasing Program.

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Payment Innovation: Quality Payment Program

MIPS Participation Lookup Tool Updated: Final 2018 MIPS Eligibility Status Now Available

Eligible clinicians can check the Quality Payment Program (QPP) Participation Status Tool to view their final 2018 MIPS eligibility status.

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Payment Innovation: Other

CMS Proposes Changes for MA and Part D Plans: Coverage Changes for Protected Class Drugs, Step Therapy Requirements and Greater Price Transparency for Medicare Beneficiaries

On November 26, 2018, CMS released a proposed rule that would allow for changes in 2020 to coverage of protected class drugs, establish new requirements for when MA plans may apply step therapy as a utilization management tool for Part B drugs and implement electronic tools to increase drug price transparency for Medicare beneficiaries.

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Payment Innovation: Advanced APMs

MedPAC Scheduled to Discuss Modifying the Advanced APM Incentive on Nov 1

MedPAC is scheduled to discuss a policy option for revising the Advanced APM incentive payment during their public meeting on Thursday, November 1.

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Payment Innovation: Other

LAN Releases Updated Report on APM Adoption

Health Care Payment Learning and Action Network released a new report on alternative payment model adoption.

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Payment Innovation: Other

ASPE’s Social Risk Request for Information

RFI released seeking provider and plan approaches to improve care for Medicare beneficiaries with social risk factors.

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Payment Innovation: Other

CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

CMS announces a number of changes to the oversight of Medicare Accrediting Organizations. CMS believes these changes will improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

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Payment Innovation: Other

CMS Releases 2019 Medicare Advantage and Part D Prescription Drug Quality Program Star Ratings

CMS has released Part C and Part D Star Ratings; providing information about the quality of plan choices.

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Payment Innovation: MIPS

Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

Rep. DelBene (D-WA) requests support in asking CMS to adjust the MIPS low-volume threshold in order to include more providers in MIPS as part of the final 2019 physician fee schedule.

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Diagnostics: OIG

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

OIG releases the fourth in a series of data briefs looking at Medicare spending under the Clinical Laboratory Fee Schedule.

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Payment Innovation: Advanced APMs

Energy and Commerce Health Subcommittee Hearing to Review Regulatory Burdens that Impede Value-Based Arrangements

On September 13, 2018 at 1:15 pm, the Energy and Commerce Health Subcommittee will hold a hearing entitled “Examining Barriers to Expanding Innovative, Value-Based Care in Medicare.”  The hearing will look at ways to meaningfully evaluate and increase the use of Medicare value-based payment arrangements.

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Payment Innovation: Other

MedPAC to Discuss Mandated Report on Clinician Payment in Medicare at September 6th Meeting

MedPAC is scheduled to discuss a mandated report on clinician payment examining the relationship between Medicare’s payments to clinicians and the supply of and quality of care provided by those clinicians report at their September 6, 2018, meeting.

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Payment Innovation: Advanced APMs

CMS Releases 2017 MSSP ACO Performance Data

CMS has released a data set showing how Medicare Accountable Care Organizations (ACOs) performed in 2017. 

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Payment Innovation: Quality Payment Program

CMS Releases First Snapshot of 2018 APM Qualifying Participant and MIPS APM Status

CMS updated the Quality Payment Program Participation Status Tool to include 2018 Advanced Alternative Payment Model Qualifying Participant and Merit-based Incentive Payment System APM status.

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Payment Innovation: Other

CMS Hosts Webinar on Public Reporting on Physician Compare

July 24, 2018 11:00 AM ET/8:00 AM PT and July 26, 2018 3PM ET/12:00 PM PT

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Health Reform 2.0: Budget Information

House GOP Proposes 2019 Budget Plan

The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19.

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Payment Innovation: Quality Payment Program

Medicare Diabetes Prevention Program Supplier Enrollment Call

On Wednesday, June 20, 2018, the Centers for Medicare & Medicaid Services (CMS), will host a call to present information about the Medicare Diabetes Prevention Program (MDPP) supplier enrollment requirements and process.

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Health Reform 2.0: Budget Information

2018 Medicare Solvency Report Released

On June 5, 2018, the Board of Trustees released the 2018 annual report on solvency of the Medicare trust funds (the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund).

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Diagnostics: Litigation

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

On Monday December 11, the American Clinical Laboratory Association (ACLA) filed a legal challenge to CMS’s implementation of the revised Clinical Laboratory Fee Schedule (CLFS) required under Section 216 of the Protecting Access to Medicare Act (PAMA) of 2014.

ORIGINAL ANALYSIS

Health Reform 2.0: Congress

H.R. 4848 (Congressman Tom Price, M.D.)

Would delay implementation of the Medicare Comprehensive Care for Joint Replacement (CJR) payment model

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Health Reform 2.0: Congress

H.R. 1650 (Congressman Tom Price, M.D.)

Expands Medicare beneficiary-physician private contracting rights

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