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.

Medicare 59

Medicare Medicaid Diabetes Download 59

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.

Medicare 49

Medicare CMS Medicaid 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.

CMS 49

CMS Medicare Medicaid Article 49

American College of Cardiology

DECEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (PFS) final rule on Nov. Of note, the 2025 PFS conversion factor is $32.3465, a reduction of 2.83% from $33.2875 in 2024.

Medicare 45

Medicare CMS Medicaid Article 45

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.

Medicare 45

Medicare CMS Medicaid Article 45

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

Medicaid 105

Medicaid Medicare Patient Care 105

DAIC

OCTOBER 16, 2024

15 , 2024 — Four of the seven Medicare Administrative Contractors (MACs) have released final local coverage determinations (LCD) for AI-Coronary Plaque Analysis (AI-CPA). tim.hodson Wed, 10/16/2024 - 12:36 Oct. The four contractors for the U.S.

CMS 52

CMS Medicare Plaque Chest Pain 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.

CMS 66

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.

Medicaid 59

Medicaid Medicare Cancer 59

American College of Cardiology

NOVEMBER 7, 2024

The Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (PFS) final rule on Nov. Of note, the 2025 PFS conversion factor is $32.3465, reduced 2.83% from $33.2875 in 2024.

Medicare 40

Medicare Reimbursement CMS Medicaid 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.

Research 111

Research TAVR Aortic valve Atrial Fibrillation 111

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. ,

CMS 111

CMS Heart Failure Reimbursement Quality of Life 111

Hypertension Journal

JANUARY 16, 2024

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

Medicaid 45

Medicaid Blood Pressure Medicare Research 45

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).

Medicaid 52

Medicaid Medicare CMS Blog 52

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.

Hospital 49

Hospital CMS Medicaid Medicare 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.

CMS 49

CMS Medicaid Medicare 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.

Medicaid 53

Medicaid Medicare Article 53

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%

CMS 49

CMS Hospital Medicaid Medicare 49

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%

Hospital 49

Hospital CMS Medicaid Medicare 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 (..)

Reimbursement 49

Reimbursement Medicaid Medicare Hospital 49

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.

Reimbursement 105

Reimbursement Electrocardiogram Technology Medicaid 105

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%

CMS 49

CMS Medicaid Medicare Inpatient 49

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 (..)

CMS 45

CMS Medicaid Public Health 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.

Outpatient 105

Outpatient Hospital Reimbursement Medicaid 105

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.

Reimbursement 45

Reimbursement CMS Medicaid Medicare 45

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.

CMS 40

CMS Medicaid Medicare 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).

Diabetes 72

Diabetes Cardiovascular Disease Drug Costs Medicaid 72

American College of Cardiology

NOVEMBER 12, 2024

The Centers for Medicare and Medicaid Services (CMS) released the 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule on Nov. The rule will implement a 2.9% increase to OPPS payment rates that reflects a market basket update of 3.4% reduced by a productivity adjustment of 0.5%.

Hospital 40

Hospital CMS Medicaid Medicare 40

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.

Hospital 40

Hospital Medicaid Medicare Ablation 40

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.

Medicare 40

Medicare Document Stroke Strokes 40

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.

Stroke 40

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%). 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

Medicaid 40

Medicaid Medicare Stroke Strokes 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

Coronary Artery Disease 105

Coronary Artery Disease Technology Stents Stent 105

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

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.

Ischemia 95

Ischemia Angina Heart Failure Outcomes 95

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).

Hospital 40

Hospital Medicare Stroke Strokes 40

DAIC

MARCH 7, 2024

The CardiAMP HF trial is supported by the Maryland Stem Cell Research Fund and has reimbursement from the Centers for Medicare and Medicaid Services (CMS) for both treatment and control procedures. The CardiAMP HF II trial is expected to similarly secure CMS reimbursement.

Heart Failure 105

Heart Failure Biomarkers Reimbursement CMS 105