Reimbursement

CMS appropriately made CAAP Program payments to all 100 providers that were randomly selected in the OIG's audit.

New Certified Community Behavioral Health Clinics receive higher reimbursement through Medicaid than community mental health centers.

The complaint charges Cigna with encouraging diagnoses that yielded higher reimbursement for MA members.

Significantly, 37 plans earned 2.5 stars, compared to just two last year, while four plans earned two stars.

CMS is expected to release the star ratings "on or about October 6."

The order vacates the drug reimbursement rate for 340B hospitals in the 2022 OPPS Rule.

Physicians see the need to reduce the gaming of risk adjustment and to create accountability focused on outcomes, not processes. 

Prior authorizations (PAs) are achieving one of the goals health plans sought - lowering drug costs. Although the process has become a growing burden for provides, payers and members, the right technology can resolve these issues.

Providers earned almost $321 million in shared savings by improving quality and reducing costs in the program's first three years.

The AMA and other plaintiffs contend the insurer significantly underpaid claims and put patients at risk of balance billing.