Medical Necessity

CMS leaders explain final plans to restrict Medicare coverage of new Alzheimer’s drug

CMS mostly finalized previously proposed criteria for coverage of Aduhelm, which has been promoted as the first drug to treat the underlying pathology of Alzheimer’s disease.

Nick Hut April 16, 2022

Medicare coverage updates include revised criteria for lung cancer screening and a code for a newly approved COVID-19 treatment

CMS in February amended its coverage requirements for lung cancer screening and issued a code for a new COVID-19 treatment.

Nick Hut March 5, 2022

Healthcare stakeholders are invited to contribute suggestions for improving prior authorization

A two-month comment period is available for healthcare stakeholders to suggest electronic standards that would make the prior authorization process more efficient.

Nick Hut January 24, 2022

News Briefs: Federal vaccination requirements finalized for hospitals and most other healthcare settings

If a hospital’s staff aren’t fully vaccinated by Jan. 4, the organization will be deemed noncompliant with Medicare and Medicaid regulations, according to a new federal rule.

Nick Hut November 30, 2021

CMS cancels regulations that would ensure coverage of breakthrough medical devices, but new legislation could fill the void

Citing patient safety concerns among other issues, CMS formally canceled a Trump administration rule that would have required Medicare to cover breakthrough medical devices.

Nick Hut November 20, 2021

AMA releases 2022 CPT code set with new options that apply to COVID-19 vaccination, digital care services and more

The new set features more than 400 CPT code changes from 2021.

Nick Hut September 10, 2021

In 2022 OPPS rule, CMS plans to reinstate policies pertaining to the inpatient-only and ASC covered-procedures lists

The 2022 proposed rule for the Outpatient Prospective Payment System would reverse 2021 policies that began to phase out the inpatient-only list of procedures and expand the covered-procedures list for ambulatory surgical centers.

Nick Hut July 21, 2021

HHS sends letter to providers, insurers reinforcing requirements for COVID-19 vaccination and testing to be free for all recipients

Xavier Becerra, secretary of HHS, issued a letter emphasizing that out-of-pocket fees for COVID-19-related services are prohibited.

Nick Hut June 13, 2021

UnitedHealthcare reverses course on new approach to emergency department claims, but perhaps only temporarily

UHC had announced this week that it would evaluate claims starting July 1 to determine whether ED visits were for emergent or nonemergent events.

Nick Hut June 10, 2021

Looming UnitedHealthcare policy on coverage of emergency department care draws opposition from hospitals, physicians

In a move strongly opposed by provider associations, UnitedHealthcare soon will start denying coverage of ED care that it deems to have been nonemergent.

Nick Hut June 10, 2021
googletag.cmd.push( function () { googletag.display( 'hfma-gpt-leaderboard' ); } );