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Today’s Hot Topics in Medicare News

Medicare deadline is Dec. 7

BY MAY CLINIC HEALTH SYSTEM: Only a few days remain for Medicare enrollees to make choices about their benefits for next year. Friday, Dec. 7 is the last day of Medicare’s annual open enrollment period, when decisions can be made about health and prescription coverage for 2019.

During annual open enrollment, persons enrolled in Medicare have a number of choices regarding their prescription coverage and health plan.

They can change to a new plan, join for the first time, disenroll from coverage, or continue with their current plan (if it is still available). (read more)

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Medicare wage index overhaul urged by HHS inspector general

BY ALEX KACIK: The tool the CMS uses to set hospital payments is often inaccurate, resulting in at least $140.5 million in overpayments to 272 hospitals from 2014 to 2017, according to a new report from HHS’ Office of Inspector General. 

The OIG’s report released Tuesday recommended an overhaul of the wage index system to mend a number of vulnerabilities. 

The CMS lacks the authority to penalize hospitals that submit inaccurate wage data and Medicare administrative contractors’ limited reviews don’t always catch inaccurate data, the report found. The wage index’s rural floor and hold-harmless provisions decrease the tool’s accuracy, the OIG said. (read more)

Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

BY KYLE MURPHY, PhD: CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump Administration’s imperative to curb the high costs of prescriptions which continue to rise.

On Monday, the federal agency announced the proposed rule set to hit the Federal Register later this week alongside a fact sheet highlighting the most important components of the rule. (read more)

Trump Medicare plan promises lower prescription prices for seniors, but also risks losing coverage of some critical cancer, HIV, depression drugs

BY BERKELEY LOVELACE JR.: The Trump administration is making good on its latest effort to lower out-of-pocket drug costs for Medicare recipients, but its approach could also limit drug options or even risk eliminating coverage of some prescriptions.

The Centers for Medicare and Medicaid Services proposed late Monday changes to Medicare Advantage and Medicare Part D. Among the changes, it would allow insurers to stop covering certain “protected” classes of drugs used to treat common ailments like depression, cancer and HIV. (read more)

Hospital Wage Data Inaccuracies Led to Medicare Reimbursement Issues

BY JACQUELINE LAPOINTE: CMS may not be appropriately adjusting Medicare reimbursement to hospitals for local labor prices, a new HHS Office of the Inspector (OIG) report reveals.

The HHS watchdog found “significant vulnerabilities” in the hospital wage index system while conducting 41 reviews of hospital wage data from 2004 to 2017. Specifically, the organization observed:

  • CMS lacks the authority to penalize hospitals that submit inaccurate or incomplete wage or occupational mix data
  • Limited reviews by Medicare Administrative Contractors (MACs) did not always identify inaccurate wage data
  • Rural floor policy decreases wage index accuracy
  • Federal and CMS hold-harmless provisions pertaining to geographically reclassified hospitals’ wage data decrease wage index accuracy

“As a result of these vulnerabilities, wage indexes may not always accurately reflect local labor prices; therefore, Medicare payments to hospitals and other providers may not be appropriately adjusted to reflect local labor prices,” the OIG wrote. (read more)

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