In CMS
Jan 25th, 2019
There are big changes on the horizon for the Medicare Part D prescription drug model, and they’re going to affect medical coders. The current reimbursement system and payment model for Part D creates incentives for plans to push patients to the “catastrophic phase.” Once the patient reaches this “donut hole,” Medicare is responsible for 80 ...
In Billing
Nov 1st, 2018
We at AAPC found the following FAQ from the Centers for Medicare & Medicaid Services (CMS) about the proposed Part D rule very interesting. Contract Year (CY) 2020 Medicare Advantage and Part D Flexibility Proposed Rule (CMS-4185-P) On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates ...
In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...
Apr 4th, 2017
In an ongoing effort to strengthen the Medicare Advantage and the Prescription Drug Program by supporting flexibility, efficiency, and innovation, the Center Medicare & Medicaid Services (CMS) released final updates to the Medicare Advantage and Part D Prescription Drug Program for 2018. The final policies are similar to the proposal released in February’s 2018 Advance Notice ...
In CMS
Sep 29th, 2015
by John Verhovshek, MA, CPC Beginning Jan. 1, 2017 the Centers for Medicare & Medicaid Services (CMS) will test Enhanced Medication Therapy Management (Enhanced MTM) model in five Medicare Part D regions: Region 7 (Virginia) Region 11 (Florida), Region 21 (Louisiana), Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming) Region 28 (Arizona) ...