CMS Announces 20 Repairs to RAC Program

Ever face the choice between trading in your old car or paying for multiple repairs?  CMS faced that kind of choice with its Recovery Audit Contractor (RAC) program.  Under the RAC program, contract auditors audit hospitals and other providers.  Guess how they’re paid?  They get a percentage of all the money …

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Pain Clinic Sues CMS Over $25 Million Repayment Demand

Alabama Pain Center thought it knew all about pain, but nothing had prepared it for the bill it received when CMS decided to retroactively “reprice” certain compounded drugs:  $25 million. The clinic is fighting back.  On Dec. 29 it filed a federal lawsuit seeking a declaration that CMS’s action—and …

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Debate Intensifies Over Medicare Advantage Plans’ Removal of Providers

Which is more important in a Medicare Advantage plan:  the plan’s flexibility to change its provider list during the plan year, or the enrollees’ right to confidence that their providers won’t be removed from the plan after they sign up? That’s the issue at the heart of an ever-intensifying debate in …

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Hospitals and Health Insurers Prodded on Same-Sex and Transgender Issues

In separate actions yesterday, CMS and the New York State insurance regulatory authority took steps to (a) assure equal treatment of same-sex spouses by hospitals and (b) insurance coverage of medically necessary transgender treatment by health insurers. The CMS action took the form of a proposed rule making it …

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CME Payments Exposed to Sunshine, But Not Too Much

Sometimes there’s less to life than meets the eye. Take the final rule issued last Friday by CMS on reporting CME (for continuing medical education) payments under the Physician Payments Sunshine Act. Under that act drug and device manufacturers are generally required to report payments to physicians. But …

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Halloween Announcement of CMS Payment Changes

Maybe it was a coincidence, but CMS waited until Halloween to announce its final 2015 payment policies for physicians and hospital outpatient departments.  While the announced changes are not really scary, one evoked sharp and immediate criticism from the American Medical Association. Generally, overall pay …

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