Reimbursement
Finance leaders are worried about the changing landscape, and many feel unprepared for what's to come.
Under the proposal, drugs would be chosen that have the lowest price, not the ones that offer the highest rebate.
The settlement also requires Aetna to implement mailing procedures that protect the confidentiality of medical information and complete a yearly compliance assessment.
CMS had hoped the threat of penalties would focus more attention on improving care quality, but most of the changes have been to coding practices.
For the first time, MA plans may lower cost sharing for drugs such as Naloxone, to treat opioid overdoses.
The data shows a trend toward comprehensive benefits and significant cost savings, though concerns remain, especially regarding consumer protections.
Use of AI led to cost reductions including a 25 percent drop in hospital length of stay and 91 percent reduction in discharges to nursing facilities.
Massive gaps leave practices more dependent on reimbursement from commercial payers and commercial contracts, raise the potential of shrinking number of Medicare patients accepted.
TPL reimbursements can recoup as much as 100 percent of charges levied, double commercial rates and more than triple governmental plan rates.
Two cases emerged from whistleblower claims about improper billing related to discounted drug prices and insulin pens.