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

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.

Medicare 45

Medicare Medicaid Article 45

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.

Medicare 43

Medicare CMS Medicaid Article 43

American College of Cardiology

DECEMBER 2, 2024

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

Medicare 41

Medicare Medicaid Article 41

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

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 41

Medicare CMS Medicaid Article 41

DAIC

JANUARY 30, 2025

This model aligns with the 2025 Centers for Medicare & Medicaid Services (CMS) initiatives, including value-based care and age-friendly health system measures, while supporting our mission to deliver improved outcomes and quality care for every patient."

Stroke 52

Stroke Strokes Outcomes Quality of Life 52

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 43

Medicare CMS Medicaid Article 43

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.

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CMS Medicare Medicaid Article 43

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 41

Medicare CMS Medicaid Article 41

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.

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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.

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CMS Medicare Medicaid Article 59

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

Becker's Hospital Review - Cardiology

JANUARY 13, 2025

"CMS proposes Medicare and Medicaid coverage for implantable pulmonary artery pressure sensors to manage heart failure. Final decision to be published on Jan.

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CMS Heart Failure Medicaid Medicare 52

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

NOVEMBER 8, 2024

Centers for Medicare & Medicaid Services (CMS) have granted the company’s Paradise Ultrasound Renal Denervation system a Transitional Pass-through (TPT) payment. tim.hodson Fri, 11/08/2024 - 09:57 Nov. 1, 2024 — Recor Medical, Inc. and its parent company, Otsuka Medical Devices Co. recently announced U.S.

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CMS Ultrasound Blood Pressure Reimbursement 40

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

JANUARY 3, 2025

The Centers for Medicare and Medicaid Services (CMS) created two new G codes in the 2025 Medicare Physician Fee Schedule final rule that will provide reimbursement for atherosclerotic cardiovascular disease (ASCVD) risk assessment and risk management services.

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Reimbursement Medicare CMS Medicaid 43

Hypertension Journal

JANUARY 16, 2024

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

Medicaid 45

Medicaid Blood Pressure Medicare Research 45

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

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

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 43

Hospital CMS Medicaid Medicare 43

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 43

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 43

Hospital CMS Medicaid Medicare 43

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 45

Medicaid Medicare Article 45

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 43

American College of Cardiology

JANUARY 8, 2025

The Centers for Medicare and Medicaid Services (CMS) has temporarily reassigned coronary CT angiography (CCTA) codes 75572-75574 from ambulatory payment classification (APC) 5571 to APC 5572 in the 2025 Outpatient Prospective Payment System (OPPS) final rule. in 2024 to $357.13 in 2025.

Reimbursement 41

Reimbursement CMS Medicaid Medicare 41

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 43

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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CMS Medicaid Medicare Outpatient 40

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 41

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

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

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 43

Reimbursement Medicaid Medicare Hospital 43

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

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 Ablation Medicare 40

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 41

Reimbursement CMS Medicaid Medicare 41

Circulation: Cardiovascular Interventions

DECEMBER 27, 2024

Utilization trends were stratified by region, urbanicity, distressed communities index, community versus academic center, Medicare versus dual enrollment status, indication, urgency, and presence of dissection with malperfusion.

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Ultrasound Aortic Medicare Medicaid 40