In case you missed it, on Nov. 20, the Centers for Medicare & Medicaid Services (CMS), a department within the U.S. Department of Health and Human Services, announced that it will overhaul the payment system for Medicare Part B (i.e., infusion) drugs on Jan. 1, 2021. The plan is called the Most Favored Nation (MFN)…
Search results for: Medicare Part B
Few Medicare Advantage Plans Cover Social Needs for Chronically Ill Patients
(Reuters Health)—Most Medicare Advantage plans are not offering chronically ill enrollees supplemental benefits to address social needs, which were added to the government health program in 2018 in an effort to improve health outcomes and achieve cost savings, a U.S. study suggests.1 Researchers examined publicly available data on benefits and plan design for Medicare Advantage…
U.S. Accuses CVS of Defrauding Medicare over Prescriptions
NEW YORK, Dec 17 (Reuters)—CVS Health Corp. and its Omnicare unit were sued on Tuesday by the U.S. government, which accused them of fraudulently billing Medicare and Medicaid for hundreds of thousands of drugs without valid prescriptions. The U.S. Department of Justice joined two whistleblower lawsuits accusing Omnicare of failing to obtain new prescriptions from…
Coding Corner Answers: Navigating Medicare’s Online Resources
Take the challenge. 1. A—Internet-only manuals Before appealing the request for an overpayment or appealing a denial, providers and staff should first verify the claim was coded and billed correctly. Second, staff should review the internet-only manuals website, which includes operating instructions, policies and procedures that cover CMS policies based on statutes, regulations, guidelines, models…
White House Preparing Order that Would Cut Drug Prices for Medicare
(Reuters)—U.S. President Donald Trump is considering a sweeping executive order that would cut prices on virtually all branded prescription drugs sold to Medicare and other government programs, according to two industry sources who had discussions with the White House. The order under discussion would be much broader than the Administration’s previously disclosed proposal to lower…
ACR Hill Visits Yield Key Bill Support; Plus Medicare, Biosimilar Wins
Greetings from Washington, D.C., where ACR leaders just held more than 100 meetings on Capitol Hill supporting reforms to step therapy and prior authorization, increased reimbursement for dual-energy X-ray absorptiometry (DXA), solutions to the rheumatology workforce shortage, and rheumatology-specific research at the Pentagon. We’re already hearing great news about our successes: Hours after our visit,…
Democrats Support Expanding Medicare, with Some Caveats that Could Matter to Voters
WASHINGTON/ST. GEORGE, S.C.—After launching his 2020 presidential bid last week, John Hickenlooper took a different stance on establishing a “Medicare-for-all” government health insurance program than many of his Democratic competitors. “I probably would oppose Medicare-for-all just because there are over 150 million people, Americans who have some form of private insurance through their business, and…
U.S. House Democrats Introduce Sweeping Medicare for All Bill
WASHINGTON (Reuters)—Democrats in the U.S. House of Representatives unveiled an ambitious proposal to move all Americans into the government’s Medicare health insurance program, tapping into public frustration over the rising cost of healthcare that has become a key issue for the party as it seeks to gain control of Congress and the White House in…
Reminder: How to Handle Part D Prior Authorization Requests
Note: Although originally posted in January 2018, the advice below remains valid. We see this issue recur each year. As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B,…
Medicare Changes Could Have Some Patients Paying More for Drugs
(Reuters Health)—A proposed shift in Medicare coverage for medicines administered by doctors may help reduce total drug spending, but a new study suggests it may also lead to higher out-of-pocket costs for some patients. Right now, drugs given by infusion or injection in outpatient settings are covered by Medicare Part B, which is part of…
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