CMS on Monday said that reimbursement rates for Medicare Advantage plans in 2007 will increase by only about 1.1% on average, rather than 4% as scheduled, because of a technical adjustment of how physicians code beneficiaries for billing, CQ HealthBeat reports. According to CQ HealthBeat, past small increases in reimbursement rates have led to...
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Part A/B
Payment Increases to Medicare Advantage Plans Lower
DEADLINE: PDPs, MA-PDs, Cost, and PACE 2007 Applications
Today is the deadline for all PDPs, MA-PDs, Cost, and PACE 2007 applications. Details on the CMS website.
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Surprise CMS Move Will Cost Hospitals for Multiple Push Injections of Same Drug
AISHealth and the 3/6/06 Report on Medicare Compliance are reporting Hospitals are about to lose money for intravenous push injections because of a surprise move by CMS, experts say. CMS said recently that hospitals can’t charge Medicare for more than one IV push injection of the same drug during the same patient encounter (HCPCS...
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CMS Issues guidance on Part B vs. D Coverage
On a January 24, 2006 conference call Craig Miner and Lawrence Kocot issued guidance on how plans should and should not be determining drug coverage under Parts B and D. “Part D plans should not be requiring a Part B rejection as their first step before they’ll start thinking about covering it under Part...
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National Provider Identifier – Subparts
Implementation of the National Provider Identifier(NPI) is moving forward. We should stay on top of the current implementation calendar and recent CMS guidance. Here is a link to the CMS site where there is a letter clarifying CMSs expectations on determining subparts to covered entities who should bill CMS using unique NPIs. Here is...
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Budget Neutrality Factor 101
Background on Payments for Medicare Advantage Plans Medicare advantage plans are private managed care plans that offer typically offer benefits beyond traditional fee for service Medicare. Plan bids outline the benefit packages offered to an area and the beneficiary contributions, if any. By law, CMS is required to publish the Medicare Advantage payment rates...
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Part D Conference Call Encore
On Tuesday, January 24, the Centers for Medicare and Medicaid Services hosted a call to discuss coverage of Medicare Part B drugs as it relates to Medicare Part D. Drugs excluded from coverage under Part D were also discussed. CMS provided an overview of the Medicare Parts B/D Issues (http://www.cms.hhs.gov/Pharmacy/) and followed by answering...
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Medicare and Pay For Performance
P4P is already on its way and most organizations that manage Medicare lines of businesses are not preparing for the changes in data collection and reporting. Here is a good article outlining the P4P programs already in demonstration with CMS and where they are headed. Now is the time for us to pay attention...
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Medicare | MedPAC Votes To Adopt Final Medicare Payment Recommendations for 2007
The Medicare Payment Advisory Commission on Tuesday voted to adopt several final recommendations to Congress for fiscal year 2007, including a plan to increase Medicare hospital inpatient and outpatient payments by the market basket increase minus 0.45%, CQ HealthBeat reports. The recommendation would result in a payment increase of 3.55% for inpatient care, with...
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CMS MAKES FIRST AWARDS TO FFS MEDICARE ADMINISTRATIVE CONTRACTORS
The Centers for Medicare & Medicaid Services (CMS) announced today that it has awarded contracts for four specialty contractors who will be responsible for handling the administration of Medicare claims from suppliers of durable medical equipment, prosthetics and orthotics. The new contracts awarded represent a first step in CMS’ initiatives designed to improve service...
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