ASRS – American Society of Retina Specialists’ Post

Join me tomorrow at 12 PM EST for an insightful conversation on "Understanding the Medicare Cost Report & 340B Implications" – presented in collaboration with the experts at Verity Solutions. Whether you're navigating the complexities of Medicare reporting or looking to deepen your understanding of 340B implications, this session will provide valuable takeaways to empower your decision-making. 🔗 Don’t miss out—register now to secure your spot! https://lnkd.in/gMMtBApF #BakerTilly #Medicare Cost Reports #340B #HealthcareFinance #Webinar #VeritySolutions

The bipartisan “Improving Seniors’ Timely Access to Care Act” has been reintroduced in Congress, aiming to change the prior authorization process in Medicare Advantage (MA). With a mandate for electronic prior authorization systems by 2027, this legislation seeks to alleviate the burdens that have long affected healthcare providers and patients alike. Key Highlights of the Bill: - Electronic Prior Authorization: Transitioning from outdated, manual processes to a streamlined electronic system. - Real-Time Approvals: Ensuring commonly approved procedures and medications receive timely decisions, reducing wait times significantly. - Transparency and Accountability: MA plans will be required to report on their prior authorization processes. - Provider Input: Emphasizing the importance of healthcare providers' perspectives in decision-making. With 135 co-sponsors in the House and 44 in the Senate, this bill has gained bipartisan support. Learn more: https://hubs.ly/Q02QQGXw0

In their new Forefront article, Sonal Parasrampuria, L. Daniel Muldoon, Neda Najmitabrizi, Mattan Alalouf, Patrick Hardy, Eliot Fishman, Purva Rawal, and Elizabeth Fowler of the Centers for Medicare & Medicaid Services Innovation Center lays out the four principles and key considerations the Innovation Center uses when setting financial benchmarks for upcoming models. "The Innovation Center uses the principles of 1) fairness and accuracy, 2) transparency, 3) alignment with model goals, and 4) scalability to the broader Medicare program. These principles seek to capture a comprehensive set of policy goals that ensure consistency, accountability, and predictability for model participants and the CMS Innovation Center across all models." Read the full article here: https://bit.ly/3C4WnVw

Explore several provisions in the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule and other recent developments from CMS. Find out all the details here: https://hubs.la/Q02P0VGQ0

BIG PICTURE: Medicare Advantage stability appears to be the storyline. "CMS: Medicare Advantage, Part D premiums are stable for 2025 "(fiercehealthcare.com). But dig into the details on a market-by-market basis, and all sorts of change is happening! Humana is exiting 13 markets (affecting 500,000 beneficiaries) while Devoted is continuing its push for scale by offering 38% more plans. Take Arkansas, for instance, Devoted is coming into 18 new counties spearheaded with a Part B giveback. This will not be your average AEP. Plan Designs are revealed by CMS tomorrow! #medicareadvantage #healthworksai

Amidst increasing pressures, Medicare Advantage plans and provider organizations can take data-driven steps to achieve mutually beneficial outcomes for all. In this joint article with our HealthScape Advisors, a Chartis Company colleagues, we explore the 4 ways payers and providers can navigate sticky issues and find common ground: https://bit.ly/3ybAJwO

https://p2a.co/y2RCf8a Need all of you to provide pressure. This is probably the MOST ignorant thing they have ever slipped in - you know pass the budget so you can see what's in it...it wasn't legislation - so that we could have a comment period etc. Put it in the budget - passed in April - now we realized it. Goes into effect tomorrow. BASICALLY - DO THE PROCEDURE, THEN YOU TALK ABOUT THE COST - THEN YOU TAKE CONSENT FOR AGREEING TO PAY FOR IT. OPPOSITE OF SURPRISE BILL, OPPOSITE OF ABN. There were a number of provisions adopted in the 2024-25 New York State Budget related to the collection of payments from patients that will go into effect on October 20. One of the concerning provisions will require physicians and other care providers to request a patient to complete a separate consent form for payment, which cannot be signed by the patient until after services are delivered to the patient. This presents a number of logistical challenges to physician practices, and could result in inability to be paid by a patient for needed healthcare services that were already delivered. Please urge the Governor and legislators to delay enforcement of this provision and pass legislation to revise this provision in the upcoming legislative session.

If you have questions or are unsure if you have the foundational basic regarding Medicare, sign up for one of our Medicare 101 workshops and learn about the options available.

🚨CMS and Congress have once again overlooked the sobering financial realities facing our nation’s medical practices, finalizing a 2.83% reduction to the 2025 Medicare conversion factor & further increasing the gap between practice expenses and reimbursement rates. Today's final rule throws the financial viability of physician practices into question and threatens beneficiary access to care. On a positive note, MGMA is pleased CMS heeded our call to finalize numerous telehealth policies, such as permanently covering audio-only services and extending flexibilities for direct supervision and home address reporting for practitioners. Congress must immediately return from recess to pass H.R. 10073, averting the 2025 cut to the conversion factor and stabilizing physician practices until a more permanent, sustainable solution to the Medicare physician payment system can be realized. https://lnkd.in/esVdQWa5

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