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13 Dec 2023, 10:16 am
For the first time, the Medicare/Medicaid folks are releasing the names of owners of Federally qualified health centers and rural health clinics, presumably to give non-Federal regulators and private attorneys a road-map of interlocking referrals and other arrangements which may jack up or fix market pricing. [read post]
12 Dec 2023, 8:09 am
Most of these individuals are dually eligible for Medicare and Medicaid benefits. [read post]
11 Dec 2023, 10:00 pm
Check out our Practical Guidance Author Center ! [read post]
11 Dec 2023, 12:57 pm
For example, according to Adam Brufsky, clinical oncologist at Pittsburgh Medical Center, at least two types of medicines—especially CDK46 inhibitors and trastuzumab-dexruxtecan (Herceptin), which were both approved under accelerated approval—have been remarkable at treating breast cancer. [read post]
11 Dec 2023, 2:00 am
False Claims Act Violations: If proven, submitting false or fraudulent claims to government healthcare programs like Medicare or Medicaid could invoke the False Claims Act. [read post]
7 Dec 2023, 8:32 am
It is good practice to have the Centers for Medicare & Medicaid Services (“CMS”) review and approve the MSA prior to the parties’ finalizing settlement. [read post]
2 Dec 2023, 2:28 pm
The underlying dispute involves petitioners' use of Medicare Part D monies. [read post]
30 Nov 2023, 9:05 pm
The Centers for Medicare and Medicaid issued a final rule updating payment systems and reporting requirements for several Medicare programs, including the Medicare Hospital Outpatient Prospective Payment System. [read post]
30 Nov 2023, 8:22 am
Over half received “below average” or “much below average” ratings from the Centers for Medicare and Medicaid Services. [read post]
30 Nov 2023, 1:00 am
Department of Justice, J.G. managed a call center that would target Medicare beneficiaries and their doctors. [read post]
29 Nov 2023, 5:04 pm
This measure, together with new pharmacy contracting requirements and related enforcement provisions also included in the bill, would represent an important—albeit limited—modification to pharmacy network contracting rules under Part D, which have been limited by the statutory “non-interference clause” barring the Centers for Medicare and Medicaid Services (CMS) from interfering in contract negotiations between pharmacies and plans or their PBMs. [read post]
28 Nov 2023, 10:00 am
This price comparison tool allows plan participants to “shop” and compare cost sharing regarding 500 “shoppable” services identified by the Centers for Medicare & Medicaid Services (CMS). [read post]
27 Nov 2023, 11:59 am
The Centers for Medicare and Medicaid Services (CMS) pays MA Plans a fixed (also known as capitated) amount for each enrolled beneficiary. [read post]
27 Nov 2023, 10:43 am
Adult day care center. [read post]
22 Nov 2023, 3:16 pm
That has led them to assisted living centers run by for-profit companies and pri [read post]
21 Nov 2023, 2:55 pm
The Centers for Medicare & Medicaid Services (CMS) classifies migraines as a disabling headache disorder “characterized by recurrent unilateral pulsatile headaches” and has assigned an ICD-10 code for billing and reimbursement purposes. [read post]
19 Nov 2023, 11:35 am
The Centers for Medicare and Medicaid Services [CMS] has published a final rule specifying how and when CMS must calculate and impose civil money penalties [CMPs] when non-group health plan [NGHP] responsible reporting entities [RRE] fail to meet their Medicare secondary payer [MSP] reporting obligations. [read post]
18 Nov 2023, 2:54 pm
Victoria Upsey arrived at Pottstown Medical Center 36 weeks into her pregnancy. [read post]
17 Nov 2023, 9:05 pm
For example, the Centers for Medicare and Medicaid Services eliminated certain restrictions on telehealth, including giving reimbursements for telehealth visits for rural and urban patients and allowing telephone-only visits, explains Copeland. [read post]
17 Nov 2023, 9:11 am
On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). [read post]
