A new report found that 13% of prior authorization denials in the Medicare Advantage (MA) program were for service requests that met Medicare fee-for-service coverage rules, likely delaying or preventing patient care. The report, conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), on the impact of prior authorization within MA found that imaging services, stays in post-acute facilities, and injections were three prominent service types among the denials that met Medicare coverage rules.
ASCO in Action provides the latest news and analysis related to critical policy issues affecting the cancer community, updates on the Association for Clinical Oncology’s ongoing advocacy efforts, and opportunities for members and others in the cancer care community to take action.
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The Provider Relief Fund (PRF) Request to Report Late Due to Extenuating Circumstances process is for providers who were required to report in an applicable reporting period, but extenuating circumstances prevented them from doing so by the required deadline. PRF Period 2 (when payment was received) covered July 1, 2020, through December 31, 2020, with an associated reporting period (RP2) of January 1, 2022, to March 31, 2022. The deadline to request to report late for RP2 is Friday, May 13, 2022, at 11:59 p.m. ET.
The Centers for Medicare & Medicaid Services released the Patient Protection and Affordable Care Act 2023 Notice of Benefit and Payment Parameters final rule. The rule finalizes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year. The rule also aims to improve enrollment policies for qualified health plans offered on the federal Marketplace to ensure consumer access to quality and affordable coverage and to advance health equity.
The Centers for Medicare & Medicaid Services (CMS) recognizes the impact that the COVID-19 pandemic public health emergency (PHE) continued to have on clinicians and the services they provided during the Quality Payment Program’s 2021 performance period. As such, CMS is reweighting Merit-based Incentive Payment System (MIPS) cost performance category from 20% to 0% for the 2021 performance period for both groups and individuals.
The Centers for Medicare & Medicaid Services issued the fiscal year 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. In addition to updating Medicare payment rates and policies for inpatient hospitals in FY 2023, the proposed rule aims to measure health care quality disparities, improve the quality of maternity care, and obtain stakeholder feedback to advance health equity.
On December 10, 2021, President Biden signed the “Protecting Medicare and American Farmers from Sequester Cuts Act,” which phased in the Medicare sequester cuts that had been paused during the COVID-19 Public Health Emergency (PHE), starting April 1, 2022. From April 1, through June 30, 2022, the cut will be 1%. The cut will return to 2% on July 1, 2022.
The Centers for Medicare & Medicaid Services (CMS) announced that it will apply the Merit-based Incentive Payment System (MIPS) automatic extreme and uncontrollable circumstances (EUC) policy to all individual Merit-based Incentive Payment System (MIPS) eligible clinicians for the 2021 performance period.
The Association for Clinical Oncology (ASCO) submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) Contract Year 2023 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs proposed rule. The rule proposes changes to advance the administration’s efforts to improve consumer protections, reduce disparities, and improve health equity in the MA and Part D programs.
The Centers for Medicare & Medicaid Services (CMS) released the 2023 Medicare Advantage and Part D proposed rule. The proposal aims to advance the administration’s efforts to improve consumer protections, reduce disparities, and improve health equity in Medicare Advantage (MA) and Part D.