American College of Cardiology

SEPTEMBER 5, 2024

The ACC submitted formal comments to the Centers for Medicare and Medicaid Services (CMS) on Sept. 4, providing feedback and raising concerns on several issues of relevance to the cardiovascular community in the 2025 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.

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Hospital CMS Medicaid Medicare 40

American College of Cardiology

AUGUST 15, 2024

The Centers for Medicare and Medicaid Services (CMS) on Aug. 15 announced the results of price negotiations for the first 10 drugs selected for the Medicare Drug Negotiation Program, made possible by the passage of the Inflation Reduction Act in 2022.

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Medicare CMS Medicaid Article 45

HCPLive

JUNE 10, 2024

Congly explains key findings from his cross-sectional study of costs associated with HBV treatment in patients on Medicaid and the economic impact of generic versus originator use.

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Medicaid 52

Circulation

JUNE 30, 2024

Circulation, Volume 150, Issue 1 , Page e1-e2, July 2, 2024.

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Medicaid Circulation 49

American College of Cardiology

AUGUST 22, 2024

The Centers for Medicare and Medicaid Services (CMS) summarized a recent billing edit change in the 2025 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, which fixes an issue that previously prevented hospitals from reporting costs for cardiac computed tomography (CT) as cardiology services.

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HCPLive

MARCH 26, 2024

A hypothetical triennial blood-based screening test meeting Centers for Medicare and Medicaid Services coverage criteria was cost-effective versus no screening but not compared to FIT, sDNA-FIT, or colonoscopy.

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Medicaid Medicare Cancer 59

American College of Cardiology

JULY 10, 2024

The Centers for Medicare and Medicaid Services (CMS) has released the proposed 2025 Medicare Physician Fee Schedule (PFS). Of note, the PFS conversion factor has been updated from $33.2875 to $32.3562, a 2.80% cut.

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CMS Medicare Reimbursement Medicaid 63

American College of Cardiology

JULY 31, 2024

Work, practice, expense and liability relative value units are updated annually through the Centers for Medicare and Medicaid Services’ Medicare Physician Fee Schedule (PFS) rulemaking.

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Medicare Medicaid Article 53

American College of Cardiology

JULY 18, 2024

The Centers for Medicare and Medicaid Services (CMS) released the proposed 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule on July 10. CMS proposes a 2.6% increase to OPPS payment rates that reflects a market basket update of 3.0%

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American College of Cardiology

AUGUST 7, 2024

The Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2025 Inpatient Prospective Payment System (IPPS) Final Rule on Aug. 1, including a 2.9% increase in operating payment rates for general acute care hospitals, representing a 3.4% increase in the hospital market basket with a 0.5%

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American College of Cardiology

JULY 16, 2024

The Centers for Medicare and Medicaid Services (CMS) released the proposed 2025 Medicare Physician Fee Schedule (PFS) on July 10, addressing Medicare payment and quality provisions for physicians in the coming year. Under the proposal, physicians will see a decrease to the conversion factor of 2.80% on Jan.

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Medicare CMS Medicaid Article 49

American College of Cardiology

JULY 17, 2024

The legislation builds on regulatory action taken by the Centers for Medicare and Medicaid Services earlier this year, requiring the use of electronic prior authorization, tightening response timelines and updating transparency requirements. The Improving Seniors’ Timely Access to Care Act of 2024 (H.R.

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Medicaid Medicare Article 53

HCPLive

FEBRUARY 13, 2024

Telehealth appointments, patients who prefer speaking non-English, older adults, and patients on Medicaid had lower odds of having a depression screening during the early COVID-19 pandemic.

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COVID-19 Medicaid 52

American College of Cardiology

DECEMBER 14, 2023

The Centers for Medicare and Medicaid Services (CMS) has paused the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging and rescinded any current regulations, according to the 2024 Medicare Physician Fee Schedule (PFS) final rule.

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CMS Medicare Medicaid Article 66

American College of Cardiology

JULY 10, 2024

The Office of the National Coordinator for Health Information Technology (ONC) released on July 10 the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule, building on the HTI-1 final rule released in 2023 and additional information blocking rules released (..)

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American College of Cardiology

APRIL 12, 2024

The Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2025 Inpatient Prospective Payment System (IPPS) proposed rule, proposing a 2.6% increase in operating payment rates for applicable hospitals. This represents a 3% projected increase in the hospital market basket update with a projected 0.4%

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CMS Hospital Medicaid Medicare 49

DAIC

APRIL 10, 2024

Respondents have received assistance from the Centers for Medicare & Medicaid Services (12 percent), state Medicaid plans (0.7 In addition to dipping into personal funds, respondents did report taking advantage of advance payments, temporary funding assistance, and loans.

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Medicaid Medicare Patient Care 105

American College of Cardiology

MARCH 11, 2024

The Centers for Medicare and Medicaid Services (CMS) announced on March 9 a new opportunity to request advanced Medicare payments for clinicians impacted by the cyberattack and resulting claims disruptions with Change Healthcare.

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Medicare CMS Medicaid Article 49

American College of Cardiology

JANUARY 24, 2024

The final Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization (PA) Rule released this month marks a major milestone in reforming prior authorization practices and reflects the ongoing work of ACC Advocacy to reduce prior authorization burden on clinicians.

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CMS Medicaid Medicare Article 49

American College of Cardiology

MARCH 21, 2024

The Centers for Medicare and Medicaid Services (CMS) has increased the Medicare Physician Fee Schedule (PFS) conversion factor by 1.68% – from $32.74 for services rendered Jan. 1 through March 8 to $33.07 for services rendered March 9 through Dec. 31 – in response to the Consolidated Appropriations Act, 2024 signed into law on March 9.

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CMS Medicare Medicaid Article 49

American College of Cardiology

FEBRUARY 15, 2024

The number of cardiac procedures being performed in ambulatory surgery centers (ASCs) has grown significantly over the last decade, and third-party payer reimbursement, led by the Centers for Medicare and Medicaid Services, have resulted in continued trends of minimally invasive cardiac procedures on stable patients increasingly being performed outside (..)

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Cassling

JANUARY 10, 2023

UPDATE: The penalty phase of the Centers for Medicare & Medicaid Appropriate Use Criteria (AUC) program has been suspended until further notice. A major goal of the AUC is to help providers order the most appropriate test for their patients by using a Clinical Decision Support Mechanism (CDSM).

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Medicaid Medicare CMS Blog 52

American College of Cardiology

JUNE 6, 2024

The ACC submitted formal comments on June 5 to the Centers for Medicare and Medicaid Services (CMS) regarding the Fiscal Year (FY) 2025 Inpatient Prospective Payment System (IPPS) proposed rule.

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CMS Reimbursement Medicaid Medicare 45

Hypertension Journal

JANUARY 16, 2024

Hypertension, Volume 81, Issue 2 , Page e7-e9, February 1, 2024.

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Blood Pressure Medicaid Medicare Research 45

HeartRhythm

APRIL 30, 2024

As of 2019, the Center for Medicare and Medicaid Services requires that each hospital publish the standard prices of the procedures it offers in a document called a chargemaster. The stated purpose of this rule is to promote pricing transparency and help patients and health plans make informed healthcare decisions.

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Hospital Medicaid Medicare Ablation 40

Circulation: Cardiovascular Quality & Outcomes

NOVEMBER 6, 2023

We then evaluated changes among low-income adults in Medicaid expansion versus non-expansion states using a similar approach.Results:The unweighted study population included 80,767 low-income and 184,136 high income adults. Low-income adults experienced improvements in insurance coverage (RR 1.10 [95% CI: 1.08-1.12]),

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Risk Factors Medicaid COVID-19 Outpatient 40

Cardiovascular Diabetology

JULY 7, 2024

The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).

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Diabetes Cardiovascular Disease Drug Costs Medicaid 72

Stroke Journal

FEBRUARY 1, 2024

Payer sources were identified as: self-pay, Medicaid, Medicare, and Private/HMO. Medicaid, and 15.3% Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source. identified as self-pay were prescribed AMPB at discharge. Differences in compliance rates were 10% for Medicare, 13.5%

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Stroke Strokes Medicaid Medicare 40

Stroke Journal

FEBRUARY 1, 2024

The insurance status of our patient population was predominantly Medicare (56.4%), followed by Commercial (26.4%), Medicaid (8.1%), and Self- Pay (2.9%). or Medicaid (10.8 The remainder were classified as Other/Missing (6.2%). mins, p = 0.7) mins, p = 0.3).Conclusions:A

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Medicaid Medicare Stroke Strokes 40

DAIC

JULY 18, 2024

CPT codes are widely used by government payers, including Medicare and Medicaid, and commercial insurance companies to identify healthcare services and procedures for reimbursement. In accordance with the AMA semi-annual early release schedule, the new codes will be effective January 1st, 2025 and published in the 2025 CPT Code book.

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Reimbursement Electrocardiogram Technology Medicaid 105

Cardiometabolic Health Congress

JANUARY 26, 2024

Get more information about this new insulin benefit Learn more about insulin costs in Part D and Part B Read the FAQ on Medicare insulin cost-sharing changes (January 2023) How to Get Insulin for Your Medicaid Patients Most Medicaid patients receive insulin for free or at a nominal cost.

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Medicare Medicaid Diabetes Download 59

DAIC

JUNE 4, 2024

HeartFlow’s accurate and actionable Plaque Analysis aligns with the Centers for Medicare & Medicaid Services (CMS) commitment to supporting technologies that enhance diagnostic accuracy and patient care: HeartFlow Plaque Analysis is the only FDA cleared plaque analysis with a reported 95% agreement prospectively compared to the gold standard, IVUS.¹

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Medicare Plaque Reimbursement Cardiovascular Disease 104

Stroke Journal

DECEMBER 14, 2023

Implantable vagus nerve stimulation, paired with high-dose occupational therapy, has been shown to be effective in improving upper limb function among patients with stroke and received regulatory approval from the US Food and Drug Administration and the Centers for Medicare & Medicaid Services.

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Stroke Strokes Best Practices Medicaid 40

Society of Thoracic Surgeons - Adult Cardiac

FEBRUARY 5, 2024

Priorities Streamline Access to Out-of-State Specialized Care : Promote expedited patient access to highly specialized care across state lines for Medicaid beneficiaries. To ensure these patients are receiving the best care possible, STS is persistent that policymakers support and invest in pediatric specialists.

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Pediatrics Congenital Cardiothoracic Medicaid 40

CardiacWire

MARCH 24, 2024

The new guidance will also likely drive more prescriptions beyond Medicare, noting that the guidance also applies to state Medicaid plans, and it could lead to coverage by commercial payers.

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Medicare Obesity CMS Medicaid 59

Journal of the American Heart Association

DECEMBER 12, 2023

Factors associated with a higher risk of potentially undiagnosed hypertension included individual characteristics (ages 40–84 compared with 18–39 years), clinical (lack of diabetes diagnosis) and health system factors (clinic site and being a Medicaid versus a Medicare beneficiary), and timing (readings obtained after the COVID‐19 Stay‐At‐Home Order (..)

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Hypertension COVID-19 Medicaid Medicare 45

Journal of the American Heart Association

FEBRUARY 16, 2024

CABG prices were not related to death, readmissions, patient ratings, or overall Centers for Medicare and Medicaid Services hospital rating.ConclusionsThere is significant variation in CABG pricing, with certain characteristics associated with higher rates, including major teaching status and investor ownership.

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Coronary Artery Bypass Graft Hospital Medicare Medicaid 40