CardiacWire

MARCH 24, 2024

Less than two weeks after Novo Nordisk’s weight-loss drug Wegovy gained expanded FDA approval for cardiovascular event risk reduction, CMS issued a new Medicare Part D guidance that allows coverage of obesity drugs for senior patients with “an additional medically accepted indication”… like cardiovascular disease.

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Medicare Obesity CMS Medicaid 59

Cardiometabolic Health Congress

JANUARY 26, 2024

However, the complexities of state-regulated insurance, Medicare insulin caps, and insulin manufacturers’ patient assistance programs create a web of resources that is complicated to navigate. How to Get Insulin for Your Medicare Patients Medicare-lowered insulin costs are automatic and will be available at any in-network pharmacy.

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Medicare Medicaid Diabetes Download 59

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 48

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and Medicaid Services (CMS) has paused the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging and rescinded any current regulations, according to the 2024 Medicare Physician Fee Schedule (PFS) final rule.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

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

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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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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Hospital CMS Medicaid Medicare 48

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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CMS Medicaid Medicare Inpatient 48

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 51

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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CMS Medicaid Public Health Medicare 44

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 48

DAIC

APRIL 10, 2024

The one-two punch of compounding Medicare cuts and inability to process claims as a result of this attack is devastating to physician practices that are already struggling to keep their doors open.” Respondents have received assistance from the Centers for Medicare & Medicaid Services (12 percent), state Medicaid plans (0.7

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Medicaid Medicare Patient Care 105

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 48

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

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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Reimbursement Medicaid Medicare Hospital 48

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 44

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

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

Stroke Journal

FEBRUARY 1, 2024

As of 2023, Center for Medicare & Medicaid Services uses NIHSS as a risk adjustment variable. Medicare and Mount Sinai Health System registry data were linked using a matching algorithm. of Medicare cases even though it was documented in 93.1% Index AIS admissions were identified using the ICD-10-CM code of I63.x.

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Medicare Document Strokes Stroke 40

DAIC

JANUARY 29, 2024

The researchers found that Medicare patients undergoing esophagectomy for cancer exhibit identifiable predictors for long-term survival and readmission. These findings suggest opportunities to enhance clinical practice and improve outcomes for Medicare patients undergoing esophagectomy for cancer.

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Research TAVR Aortic valve Atrial Fibrillation 111

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. Differences in compliance rates were 10% for Medicare, 13.5% Medicaid, and 15.3% Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source.

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Strokes Stroke 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%). When compared to the remainder of the population, we found no difference in median DIDO for patients on Medicare (-2.0 or Medicaid (10.8 mins, p = 0.7) mins, p = 0.3).Conclusions:A

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Medicaid Medicare Strokes Stroke 40

Journal of the American Heart Association

FEBRUARY 16, 2024

times the Medicare rate ($57 240 and $75 047, respectively, versus $28 398). Univariate and multivariable analyses were performed to assess factors predictive of higher prices. Across 544 hospitals, median commercial and self‐pay rates were 2.01

Coronary Artery Bypass Graft 40

Coronary Artery Bypass Graft Hospital Medicare Medicaid 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

DAIC

MARCH 13, 2024

CMS has reviewed the CardiAMP Heart Failure II Trial and approved the investigational product, related and routine items and services for purposes of Medicare coverage. Getty Images milla1cf Wed, 03/13/2024 - 16:49 March 13, 2024 — BioCardia, Inc. , Getty Images milla1cf Wed, 03/13/2024 - 16:49 March 13, 2024 — BioCardia, Inc. ,

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CMS Heart Failure Reimbursement Quality of Life 111

Stroke Journal

FEBRUARY 1, 2024

The Office of the Inspector General recently reported that 13% of Medicare beneficiaries were denied access by some Medicare Advantage Organizations to medically necessary care, including admission to inpatient rehabilitation facilities (IRF).

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Hospital Medicare Strokes Stroke 40

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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Strokes Stroke Best Practices Medicaid 40

GEMMS

APRIL 8, 2024

Established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) , the MIPS Program is pivotal in determining Medicare payment adjustments for healthcare practices. What is MIPS?

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Medicare Innovation Medicaid Patient Care 52

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

DAIC

FEBRUARY 14, 2024

Recent shifts in third-party payer reimbursement, led by the Centers for Medicare and Medicaid , have resulted in continued trends of minimally invasive cardiac procedures on stable patients increasingly being performed outside of a hospital setting.

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Outpatient Hospital Reimbursement Medicaid 105

Stroke Journal

FEBRUARY 1, 2024

They were more likely insured by Medicare, less by Medicaid, and less likely baseline ambulatory, have a Bachelor’s degree, or own a home, with lower median income.

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Strokes Stroke Medicaid Medicare 40

Stroke Journal

FEBRUARY 1, 2024

while patients with medicare/medicaid were more likely to have anxiety (OR=2.9, After applying appropriate sample weights, we identified that patients aged 65-75 and >=75 had similar odds but demonstrated decreased likelihood of depression compared to younger patients with stroke (OR=0.4, 95%CI (0.2,0.9). 95%CI (0.4,0.9)

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Strokes Stroke Medicaid Medicare 40

Stroke Journal

FEBRUARY 1, 2024

Estimates of county level SDOH were classified into quartiles and the relative odds of outcome were assessed using a multivariable logistic regression.Results:Of 1,171,519 observations included in our final analysis, median age was 71 years, 49% were female, 78% were of white ethnicity and 45% were insured through Medicaid/Medicare.

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Strokes Stroke Education Medicaid 40

DAIC

JUNE 18, 2024

We look forward to working with FDA, Centers for Medicare & Medicaid Services, and respective physician societies to bring this technology t­­o U.S. 3 “We very much appreciate FDA’s breakthrough designation recognition of the bioadaptor technology,” continued Sirhan. “We

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Coronary Artery Disease Stent Stents Technology 105

DAIC

MAY 2, 2024

The CardiAMP cell therapy trials for the indications of both chronic myocardial ischemia and ischemic heart failure are covered by the Center for Medicare and Medicaid for both treatment and control procedures. CAUTION - Limited by United States law to investigational use.

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Ischemia Angina Heart Failure Outcomes 95

DAIC

JULY 25, 2024

The CardiAMP clinical development for heart failure is supported by the Maryland Stem Cell Research Fund and is reimbursed by Center for Medicare and Medicaid Services (CMS) for both treatment and control procedures. CAUTION - Limited by United States law to investigational use.

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Heart Failure Quality of Life CMS Reimbursement 111