From Drug Benefit News - Although CMS dropped its previous proposal to significantly expand medication therapy management (MTM) from the final Medicare Advantage (MA) and Part D rule issued in May, the new plan marketing guidelines released a month later appear to encourage more widespread use of those programs without mandating them. Read more
From Health Plan Week - E-payments are increasingly a part of the payer-provider relationship, but like many other areas that define the give and take between the two sides, the transition to a paperless reimbursement system has not been without its controversies. Read more
From Inside Health Insurance Exchanges - Some insurance agents and brokers who helped individuals and small groups find health coverage through public insurance exchanges are still waiting for commission checks. Some are owed thousands of dollars for work they did last fall. Although commissions typically are paid by the carriers, HHS and some state exchanges have been slow to get the necessary information to the carriers. Read more
From Medicare Advantage News - Commonwealth Care Alliance (CCA), which already has landed about 10,000 members in the new CMS-backed initiative for Medicare-Medicaid dual eligibles in Massachusetts, will get a $10 million loan from a new nonprofit investment fund to help meet state reserve requirements that will soar in light of this huge growth. Read more
From Specialty Pharmacy News - Consumer advocacy groups in California and Florida have taken various actions against health plans and their coverage of HIV/AIDS drugs and requirements for members who take them. And while Consumer Watchdog and The AIDS Institute, in conjunction with The National Health Law Program (NHeLP), are taking somewhat different approaches, they are united in the contention that these members are being discriminated against, and the Affordable Care Act (ACA) bans health… Read more
From Report on Medicare Compliance - Some suppliers have lost their Medicare provider numbers because they were out of the office when state surveyors came by unannounced during business hours. Read more
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