Medicare

Medicare Payment Advisory Commission staff estimate CMS’ policy of basing Medicare laboratory pay rates on commercial-payer rates will save 24% on average once it is fully implemented, but they say the savings will vary based on the test type and warn independent labs’ overrepresentation in the data collection might skew rates to the lower end and affect patient access.

Medicare payment advisors voted Thursday (April 1) to recommend Congress replace Medicare Advantage’s benchmark policy with a new system that would share plans’ MA cost efficiencies with the federal government.

The American Hospital Association says the backlog of Medicare appeals is down 69% from when a federal court first directed HHS to fix the problem.

Medicare Advantage beneficiaries spent an average of $1,640 less on out-of-pocket and premium costs than traditional Medicare beneficiaries in 2018, according to a new study released by pro-MA coalition Better Medicare Alliance Tuesday (March 30).

Only about 40% of hospitals that applied to be exempt from certain site-neutral provisions for off-campus departments were granted that exemption, but the American Hospital Association says CMS was too slow in conducting audits to affirm the requests so it should either reverse the denials to the remaining 60% or allow hospitals that were denied exceptions to appeal.

As providers and lobbyists anticipated, the Senate on Thursday (March 25) passed an extension of the Medicare sequester moratorium through the end of the year, but the legislation doesn’t include a House provision that would also head off additional sequester cuts created by the American Rescue Plan.

Sen. Amy Klobuchar (D-MN) on Monday (March 22) reintroduced legislation to let Medicare negotiate drug prices, and the bill has 32 Democratic senator cosponsors, including Sen. Joe Manchin (D-WV), who has frustrated Democrats on other policies.

The American Hospital Association is hoping the Senate will pass an extension of the Medicare sequester moratorium in the next few days and CMS will take that as a signal to hold off on any provider pay cuts until after the House passes the Senate version of the legislation.

Members of the American Medical Rehabilitation Providers Association urged lawmakers to extend the timeline of the IMPACT Act, change prior authorization requirements and withdraw CMS’ review choice demonstration for inpatient rehabilitation hospitals during an advocacy conference last Wednesday (March 17).