A proposed rule that would expand the use of prior authorization and step therapy for Part D and Medicare Advantage beneficiaries has earned criticism from patient advocacy groups and praise from pharmacy groups.
Along with E/M changes for 2019 and beyond, the 2019 Medicare Physician Fee Schedule final rule contains a plethora of regulations impacting reimbursement, including new modifiers for therapists.
Q: If a patient participating in a clinical trial is allergic to one of the drugs used in the trial, how do we report the drug that is used as a substitute?
Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office.
Hospital price growth is falling, according to a November price brief from Altarum. In October, hospital price growth rose by 1.3% compared to October 2017, the lowest annual price growth rate since September 2017.
CMS announced that it achieved improper payment rate reductions in 2018 in Medicare Fee-For-Service (FFS), Medicare Part C, Medicare Part D, Medicaid, and Children’s Health Insurance Program. Notably, the fiscal year (FY) Medicare FFS improper payment rate is at 8%, which is the lowest it has been since 2010.
Novitas Solutions, Inc. plans to pursue $7.2 million in intensity-modulated radiation therapy (IMRT) overpayments to hospitals in its jurisdiction, according to an Office of Inspector General report.
