Month: November 2021

CMS Repeals Final Rule on Digital Therapeutics in A Year of Shifting Guidance

CMS Repeals Final Rule on Digital Therapeutics in A Year of Shifting Guidance

  The absence of an established, repeatable, and scalable path to commercialization and prescription of DTx has bottlenecked broader uptake, says one physician leader. Key Takeaways The Centers for Medicare & Medicaid Services has repealed its Medicare Coverage of Innovative Technology final rule. The action leaves multiple unanswered questions for digital therapeutic reimbursement, with payers […]
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The CMS Expands Medicare Coverage for Remote Patient Monitoring

The CMS Expands Medicare Coverage for Remote Patient Monitoring

  CMS has been incrementally expanding coverage for remote patient monitoring since first recognizing the platform in 2019. Through RPM, healthcare providers can use digital health tools and telehealth platforms to improve care management for patients at home, especially those with chronic conditions or who’ve been recently discharged from a hospital. The platform has the […]
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New ICD-10-CM_PCS Codes Released

New ICD-10-CM/PCS Codes Released

The implementation of the new codes is April 1, 2022. The new ICD-10-CM/PCS codes for implementation on April 1, 2022, were recently released by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). The CMS v39.1 version of the MS-DRG grouper will be released in February 2022. […]
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Humana Expands Medicare Advantage Value-Based Contract in Minnesota

The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. “This value-based agreement for Humana Medicare Advantage members is an important part of helping our members achieve their best health,” Chuck Dow, vice president and Medicare regional president for Minnesota at Humana. “We’re excited to share with […]
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Newly expanded supplemental benefits in Medicare Advantage grew 43% for 2022

Newly expanded supplemental benefits in Medicare Advantage grew 43% for 2022

Along with that growth, the number of plans offering more than one benefit increased 15%, from 175 to 202. The findings show that under the Centers for Medicare and Medicaid Services’ reinterpretation of “primarily health-related” benefits, supplemental benefit offerings in Medicare Advantage – such as home-based palliative care, in-home support services, caregiver support and therapeutic […]
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Reporting COVID-19 Vaccination Status in 2022

Reporting COVID-19 Vaccination Status in 2022

Three new diagnosis codes for reporting COVID-19 vaccination status will go into effect April 1, 2022. The codes were presented by the National Center for Health Statistics (NCHS) at the Sept. 14-15, ICD-10 Coordination and Maintenance Committee meeting, so they are not listed in the 2022 ICD-10-CM code book. The new ICD-10-CM codes for reporting […]
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early-warning-hospital-billing-errors-portend-bleakness

Early Warning: Hospital Billing Errors Portend Bleakness

Hospitals across the nation are seeing lower profits, and it’s all because of a sudden tsunami of Medicare and Medicaid provider audits. Whether it be by Recovery Audit Contractor (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or otherwise, hospital audits are rampant. Billing errors, especially “supposed bundling,” are causing a high rate […]
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Health Systems Set Sights on Risk-Based Payment in Medicare Advantage

Health Systems Set Sights on Risk-Based Payment in Medicare Advantage

Over half of health systems also said they plan to advance risk-based payments or some form of capitation in commercial lines of business. The executive survey conducted by the Healthcare Financial Management Association (HFMA) for the Guidehouse Center for Health Insights found that nearly 60 precent of health systems are looking to advance into risk-based […]
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Improper Medicare payments down $20.7B since 2014, CMS data show

Improper Medicare payments down $20.7B since 2014, CMS data show

  The number of improper payments made under Medicare fee-for-service declined by $20.72 billion since 2014, according to new figures from the Biden administration. “The continued reduction in Medicare fee-for-service improper payments represents considerable progress toward the Biden-Harris Administration’s goal of protecting CMS programs’ sustainability for future generations. We intend to build on this success […]
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