Tag: Medicare
Stakeholders try to ‘push through’
March 7, 2025Theresa Flaherty, Managing Editor
WASHINGTON – With Republicans looking to make steep cuts to government spending, it’s wait-and-see as to whether Medicare or Medicaid will be on the chopping block.
Industry stakeholders are optimistic, however, that these two large funding sources are safe – for now.
“There’s probably 10 moderate Republicans that will oppose any cuts in care – that’s kind of the third rail in politics,” says Jay Witter, senior vice president of public...
Kennedy confirmed as health secretary
February 13, 2025HME News Staff
WASHINGTON – The U.S. Senate has confirmed Robert F. Kennedy Jr. as the next secretary of the U.S. Department of Health and Human Services in a largely party-line vote of 52-48.
Sen. Mitch McConnell, R-Ky., was the lone Republican to vote no.
Kennedy will replace Acting Secretary Dorothy Fink in overseeing the Food and Drug Administration, the Centers for Disease Control and Prevention and CMS.
While Kennedy made a name for himself during the election for his focus...
Bill’s sponsors on Medicare cut: ‘The future of private practice is in dire straights’
February 3, 2025HME News Staff
WASHINGTON – A bipartisan group of 10 lawmakers in the House of Representatives has introduced a bill to stop the 2.83% cut in Medicare payments to stabilize physician practices and protect access to care.
The “Medicare Patient Access and Practice Stabilization Act,” introduced by Reps. Greg Murphy, M.D., R-N.C., and Jimmy Panetta, D-Calif., along with eight other House members, would prospectively cancel the 2.83% cut that went into effect Jan. 1.
“Physicians...
AMA supports MedPAC on payment update
January 20, 2025HME News Staff
WASHINGTON – The American Medical Association supports a recommendation from MedPAC to link next year’s physician payment update to the growth in the cost of providing care. MedPAC recently voted to recommend a 2026 payment update of Medicare Economic Index minus 1%, slightly adjusting the formula it endorsed last year to increase payment by 50% of MEI. “While neither recommendation covers the estimated inflation that physician practices face, both approaches embrace the fact that...
CMS, PDAC detail plans for new E1028 code
January 20, 2025HME News Staff
WASHINGTON – CMS has accepted some but not all NCART’s recommendations as part of its preliminary decision on the PDAC’s code application to review E1028 and establish three new codes to describe manual, swing-away and retractable or removable mounting hardware used in conjunction with medically necessary wheelchair accessories. NCART agreed with the programmatic need for the change but requested CMS consider several edits to more accurately describe the components associated with...
Proposed rule would establish more guardrails for Medicare Advantage
December 4, 2024HME News Staff
WASHINGTON – CMS is proposing changes to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to hold them more accountable for delivering high-quality care for people with Medicare.
In the Contract Year 2026 MA and Part D proposed rule, CMS proposes addressing inappropriate use of prior authorization and internal coverage criteria, including by defining the meaning of “internal coverage criteria” to clarify when MA plans can apply utilization management,...
OIG: Medicare overpaid hospitals for hospice patients
November 21, 2024HME News Staff
WASHINGTON – Medicare improperly paid acute-care hospitals an estimated $190 million over five years for outpatient services provided to hospice patients, according to a new report from the Office of Inspector General.
For 30 of 100 sample items, payments to acute-care hospitals for outpatient services provided to hospice enrollees complied with Medicare requirements. For the remaining 70 items, however, payments did not comply with the requirements.
Specifically, the OIG...
CMS: Shared Savings Program reaps savings
October 30, 2024HME News Staff
WASHINGTON – CMS says the Medicare Shared Savings Program yielded more than $2.1 billion in net savings in 2023 — the largest savings in the program’s history. “Accountable Care Organizations in the Medicare Shared Savings Program continue to deliver high-quality health care for people with Medicare and meaningful savings for the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “CMS continues to improve the Medicare Shared Savings Program for the...
Pharmacist sentenced for Medicare, Medicaid fraud
October 25, 2024HME News Staff
LONDON, Ky. – Stephanie Collins, a former pharmacist, has been sentenced to 20 months for her role in a scheme to defraud Medicare and Medicaid by billing for medications that she never dispensed to her customers. According to her plea agreement, Collins operated as a registered pharmacist and operated Stephanie’s Down Home Pharmacy, a retail pharmacy located in Corbin, Ky. The pharmacy sought reimbursement from Medicare and Kentucky Medicaid for drugs and other medical products...
William Felix on recognizing innovation, while protecting Medicare
October 18, 2024Theresa Flaherty, Managing Editor
YARMOUTH, Maine – Dr. William Felix has worn many hats throughout his career, including chief medical officer for Medicare DMEPOS and medical director of the Pricing, Data Analysis and Coding division at Palmetto GBA, but one constant is his passion for getting innovative technology into the hands of patients.
“The sooner the patient or the beneficiary can have their hands on this technology that can improve their quality of life, along with a healthy lifestyle, and their lives...