Today’s Hot Topics in Medicare

UDIs Medicare claims

Sen. Warren: Adding UDIs to Medicare claims forms should be a ‘no-brainer’

BY ZACHARY BRENNAN: Millions of Americans are implanted with various medical devices each year, though the Centers for Medicare & Medicaid Services (CMS) still lacks the ability to track which devices prematurely fail or are recalled based on claims data.

At a hearing Tuesday at the Senate Health, Education, Labor and Pensions (HELP) committee, Sen. Elizabeth Warren (D-MA) called on CMS to update the Medicare claims form to include a line for the unique device identifier (UDI) to know more about the model of device and the manufacturer. (read more)

As CVS deal looms, Aetna presses Medicare Advantage

BY BRUCE JAPSEN: Though Aetna is shedding its Obamacare, life and disability businesses, its future focus on its own or under the CVS Health umbrella will be administering health benefits to seniors eligible for Medicare.

Aetna told analysts on Tuesday that Medicare products are the “main growth driver” for the company. That likely won’t change even if Aetna’s rumored sale to pharmacy giant CVS Health comes to pass. Aetna now has more than 2.2 million Medicare members across group, individual Medicare Advantage and Medicare supplement products and is projecting growth as seniors pick among scores of plans for 2018. Medicare’s annual open enrollment runs through Dec. 7. (read more)

Medicare must-knows 

BY CATHERINE WINTERS: Signed into law in 1965, Medicare is the federal health insurance program for people 65 and older, some younger people with disabilities and people with end-stage renal disease.

What the Letters Mean:

*Parts A and B (Original Medicare) cover hospitalization and medical care, respectively.

*Part C. Also called Medicare Advantage (MA), it’s offered by private insurers that contract with Medicare and delivers Part A and Part B benefits and, often, drug coverage. Whereas Original Medicare lets you use whatever provider or hospital accepts Medicare, MAs operate like an HMO or preferred provider organization (PPO), with in-network providers and hospitals. MAs may offer some vision, hearing and dental coverage and medical savings accounts. (read more)

Opioids prevalent in Medicare set-aside settlements: Study

BY LOUISE ESOLA: An analysis on opioid prescribing and workers compensation shows that nearly 70% of federally mandated and approved California workers compensation Medicare set-aside settlements for injured workers require funding for decades of opioid use.

The study released Monday by the California Workers’ Compensation Institute also found the prescriptions were often at dangerously high levels and in conjunction with other high-risk drugs.

Medicare set-asides are insurer-paid plans in which claims administrators allocate funds from workers comp settlements to cover future medical expenses arising from a work injury that might otherwise be paid by the federal Medicare program.

The Oakland, California-based research nonprofit found that opioids are the most commonly prescribed drug for set-asides, accounting for 28% of all prescription drugs and 33% of all prescription drug allocations, which the institute says represents “significantly higher proportions than in the general workers comp population.” (read more)

Medicare rule will harm patient care by raising costs

BY 340B HEALTH / PRNEWSWIRE: The final Outpatient Prospective Payment System (OPPS) regulation published by the Centers for Medicare and Medicaid Services (CMS) today will harm patients, raise the cost of prescription drugs and other services, and undermine the vital safety net providers across the country that serve low-income and other vulnerable populations. By slashing Medicare Part B outpatient drug payments for 340B hospitals by nearly 30 percent, CMS is taking an unprecedented action that will harm patient care.

The 340B program was signed into law by President George H.W. Bush 25 years ago this week. The bipartisan program is designed to stretch the resources of hospitals that serve a significant number of low-income patients who are uninsured, underinsured, or covered by Medicaid and other public payers. It requires drug manufacturers to discount their prices for outpatient products, and the discount does not cost the government or the taxpayers a single cent. (read more)

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