Sickle Cell Disease Patients Miss Out on Decades of Life
A cohort study of Medicare and Medicaid beneficiaries with sickle cell disease (SCD) showed a life expectancy of just 52.6 years, well below that of the general population. And among SCD patients, survival varied by sex and insurance status. Men, individuals covered by Medicare for disabilities or end-stage renal disease (ESRD), and the dual-eligible were […]
How Will Medicare’s New Drug Rebate Law Work?
WASHINGTON — The Biden administration issued initial guidance yesterday on how it plans to implement the Medicare drug rebate program, which will affect doctors who administer drugs under Medicare Part B. The program, passed in August 2022 as part of the Inflation Reduction Act, requires manufacturers who raise their drugs’ prices faster than the rate […]
Medicare Advantage Plans Fielded 35 Million Prior Auth Requests in 2021
Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF). Two million of these requests, or 6%, were fully or partly denied, according to Jeannie Fuglesten Biniek, PhD, associate director of the Program on Medicare Policy, and Nolan Sroczynski, MSPH, […]
Worried About Your Medicare Payment Because of the Debt Limit? Don’t Be, Experts Say
WASHINGTON — Clinicians should be “concerned but not panicky” about the potential effects on Medicare, Medicaid, and other healthcare payments as the federal government approaches a “debt ceiling,” experts say. “The federal government has never defaulted,” said Bill Hoagland, senior vice president of the Bipartisan Policy Center, a nonpartisan think tank here. Healthcare providers “should […]
Medicare Advantage Plans Take Top Spot in Shkreli Awards
Medicare Advantage plans took the top spot in this year’s Shkreli Awards, the annual list from the Lown Institute that calls attention to some of healthcare’s most greedy and unethical behavior. The plans’ penchant for defrauding or overbilling Medicare by an estimated $25 billion in 2020 alone by saying beneficiaries were much sicker than they […]
MedPAC Commissioners Mull Proposals to Change Part B Drug Payment
WASHINGTON — Members of the Medicare Payment Advisory Commission (MedPAC) spoke up Friday in favor of considering new approaches to the way Medicare pays for Part B drugs. “I think we’re going in the right direction,” said commissioner Gary Poulsen, MBA, of Intermountain Healthcare in Salt Lake City, Utah. “I think this is an improvement.” […]
HHS Proposes Wide-Ranging Rule Barring Discrimination in Healthcare
WASHINGTON — What has 308 pages and discusses everything from pregnancy to Medicare Part B? It’s the proposed rule from the Department of Health and Human Services (HHS) implementing the non-discrimination parts of the Affordable Care Act (ACA). The proposed rule, which was published August 4 in the Federal Register, implements Section 1557 of the […]
Medicare’s Proposed Physician Fee Schedule a Mixed Bag, Doc Groups Say
WASHINGTON — Physician group responses to the proposed 2023 Medicare Physician Fee Schedule ranged from disappointment over the proposed 4.4% overall payment cut to praise for many of the provisions related to accountable care organizations (ACOs). “The scary part for most of us is we’re getting these reductions despite the fact that we’re still fighting […]
Medicare Beneficiaries Need More Help Navigating the Program, Experts Say
More needs to be done to help Medicare beneficiaries — especially low-income beneficiaries — navigate their participation in the program, several experts said Friday. “Low-income Medicare beneficiaries navigate complex and fragmented sources of insurance coverage … not just within Medicare, between the choice of a Medicare Advantage plan or traditional Medicare, but also from the […]
Report: Medicare Advantage Plans Wrongly Deny Care, Physician Payments
Medicare Advantage plans often denied medically necessary care to beneficiaries and payments to doctors that met Medicare coverage rules, according to a new report from the HHS Office of the Inspector General (OIG). OIG found that 13% of prior authorization requests that were denied met Medicare coverage rules, as did 18% of physician payment requests […]