Program Integrity
On June 29, Sen. Bill Cassidy, R-La., unveiled a legislative discussion draft titled the 340B Drug Pricing Integrity and Affordability for Patients Act.
Reps. Scott Peters, D-Calif., and John Joyce, R-Pa., introduced the Strengthening the Exercise of Controls and Upgrading Requirements for Efficiency in 340B Act, or SECURE 340B Act.
Centers for Medicare & Medicaid Services (CMS) May 15 released its 2027 final standards for the health insurance marketplaces, including the issuers and brokers who assist marketplace enrollees. Notably, the final rule allows for the certification of nonnetwork health plans as qualified health…
The Centers for Medicare & Medicaid Services (CMS) Feb. 9 released its 2027 proposed standards for the health insurance marketplaces, including the issuers and brokers who assist marketplace enrollees.
AHA's comments on the Centers for Medicare & Medicaid Services’ final rule with comment period on program integrity enhancements to the provider enrollment process. The agency indicates that this final rule is part of its ongoing effort to protect the Medicare program from improper behavior.
On April 9, CMS issued a final rule and related guidance that will implement the standards governing health insurance issuers and the Health Insurance Marketplaces for 2019. In the rule, CMS provides details on the benefit and payment parameters for qualified health plan issuers selling in the…
In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments. These audit contractors include recovery audit contractors (RACs) and Medicare administrative contractors (…
The HHS Jan. 13 issued a final rule that makes changes to the procedures for Administrative Law Judge appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals.