Sheppard Mullin Richter & Hampton LLP’s Post

2023 was certainly an eventful year for both Congress and federal agencies such as the Centers for Medicare and Medicaid Services (CMS). However, much of their policy efforts from 2023 remain unfinished which sets up 2024 as a year for more legislative and regulatory activity. 2024 being an election year makes it difficult to predict exactly how productive Congress and the federal agencies will be. Many important decisions will be held until the end of the year after the results of the election. While we do not know the exact outcome, we know many of the top policy priorities for both Congress and CMS. Read our Preview of the Federal Health Policy in 2024. https://bit.ly/48e8jOF

In Westlaw Today, Christine Moundas, Gideon Palte and Carolyn Lye, MD, JD Lye discussed the Centers for Medicare & Medicaid Services-for-Medicare-&-Medicaid-Services final rule on electronic prior authorization requirements for payers and providers. #Medicare #Medicaid #digitalhealth #healthIT

How could the CY 2025 PFS Proposed Rule affect your obligations regarding reporting and returning Medicare overpayments? Attorney George Breen examines the implications of the proposed rule for false claims. #AffordableCareAct #Medicare #HealthCare

The way in which Medicare reimburses providers in traditional fee-for-service is based on an out of date and opaque coding structure that then distorts both the private and public markets. This recent piece in Health Affairs Forefront written by James C. Capretta, David N. Bernstein and myself dives into the complexity of the current system and potential ways to improve it. https://lnkd.in/eJ2FH5ZR

Did you know about the changes to the Medicare Physician Fee Schedule conversion factor? Spoiler alert - It's going up. Learn more about this change and more in this summary!

Prior authorization in Medicare Advantage remains a hot topic that has frustrated providers and paitents. New regulations aim to improve access and set a standard by 2025, but challenges remain. What are your thoughts on the future of prior authorization in MA? What should the new standard be? #healthcare #medicare #priorauthorization https://lnkd.in/gszgaceX

Protecting Seniors' Healthcare: Biden's Plan Threatens Medicare Advantage Benefits #benefits #BidenAdministration #campaignpromises #choices #costreduction #Coverage #fraud #governmentcontrol #governmentrole #healthcare #medicalservices #MedicareAdvantageplans #negativeimpact #patientaccess #prescriptiondrugs #qualityhealthcare #representatives #seniorcitizens #seniors

The 2/28 Healthcare Labyrinth Newsfeed is live. Click below to read. Major stories: -- Update on government shutdown -- Mississippi may expand Medicaid -- with a catch -- FTC accuses PBMs of stonewalling investigation #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth

The 3/20 Healthcare Labyrinth Newsfeed is live. Click below to read. Major stories: -- Budget deal reached -- Lawsuits against Change Healthcare -- Health equity change will have big impact on MA Star -- CBO says weight-loss drugs cost over a decade in Medicare -- GA Medicaid expansion criticized #healthcare #healthinsurance #healthcarereform #healthcarelabyrinth

CMS Report Details Total Complaints Related To No Surprises Act And ACA Compliance Fierce Healthcare (8/21, Tong) says CMS “issued a new report Tuesday detailing total complaints related to the No Surprises Act and Affordable Care Act compliance.” The report indicated that “providers and consumers earned $4.18 million in relief after the agency received more than 16,000 complaints, as of June 30. More than 12,000 complaints were tied to the No Surprises Act compliance, while 248 were about Affordable Care Act compliance.” Approximately “3,000 cases are still open.” About “35% of closed cases found no violation.” https://lnkd.in/gTqfGEru