Course | Basic | Medicare Payment and Reimbursement
In this course we will address scheduling processes, including<div><ul><li>Patient identification</li><li>Requested service</li><li>Medical necessity screening</li><li>Medicare Advance Beneficiary Notice of Noncoverage processing</li><li>Pa...
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Course | Overview | Medicare Payment and Reimbursement
This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recen...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides an overview of the prospective payment systems used in the Medicare program and as well as Medicare fee schedules. This course provides a general discussion and overview of Medicare reimbursement under the Inpatient Pro...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective paym...
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On Demand Webinar | Intermediate | Medicare Payment and Reimbursement
As the senior population continues to outpace the relative growth of the general population, and Medicare Advantage is accounting for about one-third (and growing every year) of all new Medicare eligible enrollees, providers are increasingl...
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Fact Sheet | Medicare Payment and Reimbursement

Medicare Advantage for Years 2020 and 2021 Final Rule Summary

Fact Sheet | Medicare Payment and Reimbursement

Medicare Advantage for Years 2020 and 2021 Final Rule Summary

This document provides a detailed summary of the final rule containing policy and technical changes to Medicare Advantage and other programs for 2020 and 2021.

On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services (HHS) placed on public display a final rule providing for policy and technical changes to Medicare Advantage (MA), Part D prescription drug plans, PACE and Medicaid for 2020 and 2021. The rule, set to be published in the Federal Register on April 16, 2019, implements certain provisions of the Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115- 119), including expanding the ability of MA plans to provide additional telehealth services as a basic benefit, and revising the appeals and grievances requirements and better integrating standards for enrollees in Dual Eligible Special Needs Plans (D-SNPs). In addition, it makes changes to methodologies and other updates to the Part C and D Star Ratings for 2022 and 2023 and makes several revisions and additions to the preclusion list provisions finalized in the April 2018 MA/PD final rule.

The final rule does not address provisions of the proposed rule involving the MA Risk Adjustment Data Validation (RADV) program. These include CMS’ intent to use extrapolation to estimate contract-level improper payments and several proposed methodological changes. Because CMS later extended the comment period for those RADV provisions until April 30, 2019 (83 FR 66661), CMS intends to address those changes in later rulemaking.

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