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Articles by Ellen Pighini
Proposed Rule Could Enhance Contraceptive Coverage If It Survives New Administration
On October 21, 2024, the U.S. Department of Health and Human Services, Labor Department, and the Treasury Department (collectively "the Departments") jointly released a proposed rule that would require insurers to expand coverage of and eliminate cost sharing on certain preventative services, including over-the-counter ("OTC") contraceptive items and certain Food and Drug Administration ("FDA") approved prescription birth control medications.
Renewed Focus On Upcoding And Medicare Advantage Overpayments In Light Of Recently Proposed Bipartisan Legislation
On March 28, 2023, Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) introduced a bipartisan bill targeting the Medicare Advantage patient risk scoring reimbursement methodology. Senators Cassidy and Merkley claim that the proposed legislation will reduce upcoding risks by improving the way the Medicare Advantage providers and plans assess patients' wellness and determine health risks.
Renewed focus on upcoding and Medicare Advantage overpayments in light of recently proposed bipartisan legislation | JD Supra
April 28, 2023 Nicole Aiken-Shaban, Scot Hasselman, Ellen Pighini Reed Smith + Follow x Following x Following - Unfollow Contact To embed, copy and paste the code into your website or blog: On March 28, 2023, Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) introduced a bipartisan bill targeting the Medicare Advantage patient risk scoring reimbursement methodology.
Proposed legislation to tackle Medicare Advantage upcoding in response to overpayment concerns | JD Supra
Skip to content On March 27, 2023, two United States Senators, Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) introduced the bipartisan No Unreasonable Payments, Coding, or Diagnoses for the Elderly (“No UPCODE”) Act to address perceived financial incentives inherent in the Medicare Advantage patient risk scoring reimbursement methodology. Senator Merkley alleges that the current reimbursement methodology has resulted in billions in overpayments on an annual basis.
Proposed legislation to tackle Medicare Advantage upcoding in response to overpayment concerns
On March 27, 2023, two United States Senators, Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) introduced the bipartisan No Unreasonable Payments, Coding, or Diagnoses for the Elderly (“No UPCODE”) Act to address perceived financial incentives inherent in the Medicare Advantage patient risk scoring reimbursement methodology. Senator Merkley alleges that the current reimbursement methodology has resulted in billions in overpayments on an annual basis.
OIG allows drug company to provide free medication during coverage determination delay | JD Supra
On February 28, 2023, the Department of Health and Human Services’ Office of Inspector General (“OIG”) issued a favorable advisory opinion regarding an arrangement through which a pharmaceutical company provides free enzyme replacement therapy (“ERT”) medication to patients who satisfy certain eligibility requirements where the patients’ insurer is delayed in making a coverage determination.
OIG allows drug company to provide free medication during coverage determination delay
On February 28, 2023, the Department of Health and Human Services’ Office of Inspector General (“OIG”) issued a favorable advisory opinion regarding an arrangement through which a pharmaceutical company provides free enzyme replacement therapy (“ERT”) medication to patients who satisfy certain eligibility requirements where the patients’ insurer is delayed in making a coverage determination.
OIG allows drug company to provide free medication during coverage determination delay
On February 28, 2023, the Department of Health and Human Services’ Office of Inspector General (“OIG”) issued a favorable advisory opinion regarding an arrangement through which a pharmaceutical company provides free enzyme replacement therapy (“ERT”) medication to patients who satisfy certain eligibility requirements where the patients’ insurer is delayed in making a coverage determination.
Departments issue new Final Rule and guidance materials for No Surprises Act IDR process
On August 26, 2022, the Departments of Health and Human Services, Labor, and Treasury (the “Departments”) issued the highly anticipated Requirements Related to Surprise Billing (“August 2022 Final Rule”) and associated guidance materials concerning the independent dispute resolution (“IDR”) process established by the No Surprises Act.
CMS levies penalties for non-compliance with Hospital Price Transparency Rule
The Centers for Medicare & Medicaid Services (“CMS”) issued the first round of civil monetary penalties to two hospitals in Georgia for failure to comply with the requirements of the Hospital Price Transparency Final Rule (the “Rule”) on June 7, 2022.
OIG blesses digital health substance use disorder treatment program paid for by providers and suppliers
The Department of Health and Human Services’ Office of Inspector General (“OIG”) recently issued a favorable advisory opinion to a digital health company that offers direct monetary incentives to patients as part of a technology-enabled contingency management program for patients with substance use disorders.
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