CMS released the Notice of Benefit and Payment Parameters for 2019 final rule April 9 to give states additional flexibility when choosing benefits in essential health benefit benchmark plans offered under health insurance marketplaces.
CMS recently released its annual report of Health Insurance Exchange open enrollment, which revealed that open enrollment is down from 12.2 million in 2017 to 11.8 million for 2018.
An audit of Medicare Part B payments from 2014 through 2016 revealed that CMS improperly paid providers more than $66.3 million for specimen validity tests billed in combination with urine drug tests, according to a report by the OIG.
The expected growth in healthcare expenditures from 2017 to 2026 is expected to outpace the growth in gross domestic product (GDP) by 1%, resulting in an increase in the health share of the GDP from 17.9% in 2016 to 19.7% in 2026, according to a CMS report.
CMS recently released guidance on submitting claims and filing appeals as it rolls out its new Medicare cards. The new cards will replace the Health Insurance Claim Number, which is based on the beneficiary’s Social Security Number (SSN), with a Medicare Beneficiary Identifier that is not tied to the beneficiary’s SSN.
The 2018 OPPS final rule, published in the Federal Register on November 13, has two changes that could affect case managers—the removal of the total knee replacement from the inpatient-only list and cuts to payments for drugs purchased through the 340B drug discount program.
CMS is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released in November.
Effective January 1, 2018, Medicare payments for X-rays taken using computed radiography will be reduced by 7%, according to a policy CMS finalized in the 2018 OPPS final rule. This reduction will remain effective until 2022, and increase to 10% beginning in 2023, as required by paragraph 1848 (b)(9) of the Social Security Act.
U.S. District Court Judge Rudolph Contreras will hold a hearing December 21 for a lawsuit aimed at halting the CMS payment reduction for hospital outpatient drugs acquired through the 340B program, a policy set to go into effect January 1.
The acute kidney injury (AKI) dialysis payment rate is $232.37 for CY 2018, as updated by CMS in the 2018 End-Stage Renal Disease Prospective Payment System (ESRD PPS)
