Articles and Blogs

Medicare Part B

Additional Telehealth Benefits Coming to Medicare Advantage in 2020

[07/12/19]

Posted on July 12, 2019 in Health Law News

Published by: Hall Render

Thanks to a final rule issued by the Centers for Medicare & Medicaid Services (“CMS”) this spring, Medicare Advantage (“MA”) plans will now be able to offer additional telehealth benefits to enrollees starting in 2020. Historically, MA plans have been able to offer more telehealth services compared to Original Medicare as part of their... READ MORE

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340B Moving Forward: Legislative and Executive Branch 340B Priorities for 2019-2020

[04/19/19]

Posted on April 19, 2019 in Health Law News

Published by: Hall Render

We continue to receive questions regarding the future of the 340B drug discount program (“340B Program”) now that its mid-term longevity is no longer in doubt. These include whether Congress will continue to focus on limiting the 340B Program’s scope as well as what effect, if any, broader efforts to reduce drug costs might... READ MORE

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Medicare Paid Twice for Ambulance Services Subject to SNF Consolidated Billing

[04/19/19]

Posted on April 19, 2019 in Health Law News

Published by: Hall Render

Summary In a February 2019 report, No. A-01-17-00506, HHS Office of the Inspector General (“OIG”) determined that Medicare made Part B payments to ambulance suppliers for transportation services that were covered through the Medicare Part A payments to skilled nursing facilities (“SNF”) as part of consolidated billing requirements. With certain exceptions, the SNF Part... READ MORE

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Potential Changes in Reimbursement May Jeopardize Leasing Arrangements with Dialysis Providers

[03/06/19]

Posted on March 6, 2019 in Health Law News

Published by: Hall Render

During a speech on March 4, 2019, Secretary of Health and Human Services Alex Azar announced that the Trump administration plans to overhaul the Medicare payment system for certain dialysis services provided to patients with end-stage renal disease. The overhaul, as envisioned, would incentivize moving the place of treatment from outpatient clinics to home... READ MORE

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Clinical Diagnostic Labs Enter a New Collection and Reporting Period as Medicare Payment Updates Continue

[01/18/19]

Posted on January 18, 2019 in Health Law News

Published by: Hall Render

January 1, 2019 marked the start of a new data collection period for laboratories pursuant to the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule (“CLFS Rule”).¹ The CLFS Rule establishes the Centers for Medicare & Medicaid Services’s (“CMS’s”) new private payor-based rate-setting system for clinical diagnostic laboratory tests (“CDLTs”) paid under the... READ MORE

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CMS Proposes Major Change to Medicare Part B Drug Payment System Introducing International Pricing Index Model

[11/09/18]

Posted on November 9, 2018 in Health Law News

Published by: Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) Center for Medicare and Medicaid Innovation proposed to lower the cost of Medicare Part B outpatient prescription drugs by establishing their prices based on lower drug prices of other advanced industrial nations as compiled in an “international price index” (“IPI”) and changing the way the current drug... READ MORE

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CMS Allows Medicare Advantage Plans to Implement Step Therapy for Part B Drugs – Will It Really Lower Drug Costs or Simply Increase Administrative Burdens?

[09/19/18]

Posted on September 19, 2018 in Health Law News

Published by: Hall Render

On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE

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340B Program OPPS Payment Reductions and Legislative Limitation Proposals: What’s Smoke and What’s Fire?

[07/27/18]

Posted on July 27, 2018 in Health Law News

Published by: Hall Render

On July 25, the Centers for Medicare & Medicaid Services (“CMS”) issued its 2019 Outpatient Prospective Payment System (“OPPS”) Proposed Rule (“OPPS Proposed Rule”). As anticipated based on public comments made by Department of Health and Human Services (“HHS”) Secretary Alex Azar, CMS is proposing to expand application of reduced payment for discounted drugs... READ MORE

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