Prescription Benefits

CMS Final Rule for Drug Prices in Advertising

[vc_row][vc_column][rev_slider_vc alias="cms-final-drug-rule"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]A rule proposed in October of last year has become final on May 8, 2019. This rule would mandate that pharmaceutical companies publish the prices of any medication with a list price greater than $35 during television ads. Pharmaceutical companies tried to push back on this rule stating that listing the prices would confuse patients since what they pay will be different due to insurance coverage, rebates, and discounts....

Donna White
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CMS Spending Growth

CMS Projects Exponential Growth of Healthcare Spending

[vc_row][vc_column][rev_slider_vc alias="spending-growth"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text] A new report from CMS recently published in Health Affairs, states that the US is projected to spend $5.96 trillion on healthcare in 2027. This would be a 19.4 percent share of the gross domestic product (GDP). In 2017, healthcare spending accounted for 17.9 percent of the GDP. The largest catalyst behind this projected growth is the aging population. With people living longer and reaching the age of Medicare...

Donna White
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Increased Spending

Private Insurers, not Medicare or Medicaid, are behind increased healthcare spending

[vc_row][vc_column][rev_slider_vc alias="increased-spending"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text] A new study released this week by The Urban Institute shows that Medicare and Medicaid spending is increasing more slowly than with Private Insurers, contrary to some of the policy proposals that have been put forth in recent years. According to the study of CMS data between 2006 and 2017, “Medicare and Medicaid spending per enrollee grew 2.4 percent per year and 1.6 percent per year, respectively, compared to...

Donna White
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2018 year in review

2018: A Year in Review

[vc_row][vc_column][rev_slider_vc alias="2018-in-review"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]We’re not exactly sure how, but 2018 has truly seemed to be an incredibly long year. That could be because of so many top news items in healthcare over the year. We thought we’d take this time as the year winds down to highlight some of the top items from our blog over the last year. Early in the year we discussed your charge master and how critical it...

Donna White
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Chatbots in Healthcare

Using Chatbots in Healthcare

[vc_row][vc_column][rev_slider_vc alias="chatbots"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]They’re becoming an everyday tool on the internet and our phones: chatbots. What is a chatbot? It is a computer program designed to simulate a conversation with human users. Examples of chatbots include The Amazon Echo, commonly known as Alexa. There is also a political engagement platform called Resistbot, where voters can check their registration and find out where their polling locations are. Chatbots are becoming popular for...

Donna White
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Prescription Benefits

CMS Proposed Changes to Prescription Benefits

[vc_row][vc_column][rev_slider_vc alias="change-to-rx-benefits"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]At the end of last month, CMS proposed a rule to change some key components of prescription coverage for Medicare Part D and Medicare Advantage beneficiaries. The key change revolves around the six protected classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for transplant rejections, antiretrovirals and antineoplastics (typically cancer treatment drugs). The six protected classes acknowledge that beneficiaries may need access to more than one drug in a particular therapeutic class. The...

Donna White
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CMS Final Rule 2019

CMS Final Rule 2019

[vc_row][vc_column][rev_slider_vc alias="cms-2019-final-rule"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]November sees the publishing of Medicare’s final rules for 2019. It has allowed for sweeping changes to Telehealth, provider reimbursement and Quality reporting. Medicare will now reimburse for patients connecting with their provider in a telecommute session to determine if an in-office visit is necessary. Changes made to the Quality Payment Program (QPP) will shift the focus from paperwork to positively impacting health outcomes. The key focus is on sharing...

Donna White
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Prescription Benefits

Controlling Prescription Drug Costs

[vc_row][vc_column][rev_slider_vc alias="rx-costs"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]Last week, the Trump administration announced the first mandatory CMS pay model to reign in the cost of prescription drugs. This proposal from the Department of Health & Human Services is a two-step process. One would be to decrease drug rates paid by Medicare Part B by indexing them to be in line with the lower prices paid by other developed nations. The other would be to change the...

Donna White
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Open Letter

Open Letter to CMS on Proposed E/M Rule

[vc_row][vc_column][rev_slider_vc alias="open-letter-cms"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]The Patient-Centered Evaluation and Management Services Coalition submitted an open letter to Congress in September sharing their concerns over the new proposed 2019 rule. For more on the details of this rule, check out Part 1 and Part 2. Their concerns are not only over the new payment structure but the documentation guidelines as well: “We have significant concerns that the coding and payment aspects for the Rule, as currently...

Donna White
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site neutral

Medicare Advantage Denials

[vc_row][vc_column][rev_slider_vc alias="medicare-advantage-denials"][/vc_column][/vc_row][vc_row][vc_column width="1/2"][vc_column_text]We have talked about managing denials in the past, but have rarely gotten payor specific. In this recent article from Healthcaredive.com, they targeted in on Medicare Advantage plans. This stems from an investigation by the HHS Office of Inspector General. They have discovered a high number of overturned denials for Medicare Advantage organizations. Three-fourths between 2014-2016 to be clear. That’s three quarters of Medicare Advantage denials appealed and overturned. ...

Donna White
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