Within the last few months, the Centers for Medicare and Medicaid Services (CMS) has issued guidance that will reduce the financial burdens of paying for prescription drug coverage for Medicare patients. The... Read more »
USE OF AI IN COVERAGE DETERMINATIONS Stakeholders have raised questions concerning the role of artificial intelligence (AI), algorithms and similar tools in making coverage determinations. This discussion has attracted more attention as... Read more »
On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced a new innovation model designed to improve quality of care and behavioral and physical health outcomes for Medicaid and... Read more »
In the Calendar Year (CY) 2024 Medicare Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems Final Rule, the Centers for Medicare & Medicaid Services (CMS) increased OPPS and... Read more »
The Centers for Medicare & Medicaid Services (“CMS”) continued its efforts to increase oversight of the Medicare program by updating Medicare provider enrollment regulations and policies through recent regulatory and sub-regulatory actions.... Read more »
In this episode of the Diagnosing Health Care Podcast: Under the Biden administration, the Centers for Medicare & Medicaid Services published a health equity framework that drastically changed the playing field for... Read more »
CMS said Friday that it will lower the administrative fee that providers and insurers must pay when initiating a reimbursement dispute under the No Surprises Act. This move came a week after... Read more »