Medicare & Medicaid
The managed care organizations in the review denied one out of every eight requests for prior authorization in 2019.
The scheme involved genetic testing and durable medical equipment that patients did not need, which the defendants procured with kickbacks.
CMS is proposing to update OPPS payment rates for CY 2024 for hospitals that meet applicable quality reporting requirements by 2.8%.
CMS is also proposing increases in payment for many visit services, such as primary care, and changes impacting cancer treatment.
For health plans, authors expect the study can provide a better understanding of the core customer segments of MA.
The allegations involved HCA billing Medicaid improperly for three separate behavioral health services available to children who qualify.
The lawsuit argues that Medicare is required to institute the payment model changes in a budget neutral manner.
Aspects of this proposed policy will affect nearly all hospitals paid under the Outpatient Prospective Payment System, CMS says.
Leqembi is the first amyloid beta-directed antibody to be converted from an accelerated approval to a traditional approval.
The concern is that the QBP overpays MA organizations and does not encourage quality improvement or help beneficiaries select plans.