Aduhelm’s costs: Medicare recipients won’t get premium reduction until 2023
By
Alicia Lasek (f3)
Jun 01, 2022
A cost overestimate that bumped up Medicare premiums for seniors in 2022 will not be corrected until the following year. The spike is tied to coverage for Alzheimer’s drug Aduhelm.
Providers suffering Medicare appeals backlog — at their own hand?
By
James M. Berklan
Apr 29, 2015
If providers were charged a fee for challenging Recovery Audit Contractor findings, there wouldn’t be the current overwhelming backlog of Medicare appeals, says the administration — and, surprise,...
Providers receive reprieve on advanced Medicare loan repayments
By
Danielle Brown
Oct 09, 2020
Providers who participated in the Medicare Accelerated and Advanced Payment Program for COVID-19 emergency will now have another year to pay back the loan thanks to Congress.
Obama sending mixed message on Medicare prescription prices
Apr 30, 2015
Prescription drug prices are likely to resurface as a hot political potato in the looming presidential race, beginning with the president’s recent bombshell that he wants to let Medicare bargain...
RAC groups battle provider plea for short-stay payment relief
By
John Hall
Feb 19, 2015
Third-party firms that audit Medicare bills for payment issues are pushing back hard against a hospital association plea for more favorable short-stay reimbursements, adding to the ongoing unwelcome specter...
Obtaining critical claims data may soon get easier
By
John O'Connor
Jun 05, 2015
The government plans to make new claims data and other resident-care information available to providers and entrepreneurs as never before. Is it too good to be true?
CMS proposes appeals process for Medicare patients placed on observation stay
By
Josh Henreckson
Jan 02, 2024
Medicare patients initially admitted to hospitals as inpatients but later reclassified as outpatients under observation would finally have a process to appeal those decisions, thanks to a long-awaited...
An insider’s guide to managed care contract exclusions
By
Susie Mix
Dec 18, 2023
There’s a key question more providers need to know the answer to: What is a contract exclusion? A contract exclusion details the medications and treatments that are not included in the levels of a managed...
‘Not a shock:’ MedPAC considering 5% pay cut for SNFs
By
Danielle Brown
Dec 14, 2021
The Medicare Payment Advisory Commission is leaning toward recommending a 5% pay cut for skilled nursing facilities in fiscal 2021 after a new report found that Medicare margins may indicate SNF pay rates...
Eli Lilly expects Medicare about-face on Alzheimer’s drugs coverage
By
Alicia Lasek
Apr 23, 2023
New data on Lilly’s experimental drug donanemab may influence CMS’s restrictive stance on coverage of this and other amyloid-busting Alzheimer’s treatments, a company executive says.