What reimbursement issues should be considered when a clinical trial is being developed?
Find out »

News & Insights

CMS Issues Final Rule – Deadline for ICD-10-CM – October 1, 2015   Aug 01, 2014
On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. This rule requires the continued use of ICD-9-CM coding through September 30, 2015. READ MORE »

Trustees Report shows continued reduced cost growth, longer Medicare solvency   Jul 28, 2014
The Medicare Trustees today projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Due in part to cost controls implemented in the Affordable Care Act, per capita spending is projected to continue to grow slower than the overall economy for the next several years.READ MORE »

CMS Issues Final Rule for Exchange and Insurance Market Standards for 2015 and Beyond   May 22, 2014
On 5/16/2014, CMS released a final rule on Exchange and Insurance Market Standards for 2015 and beyond. This lengthy rule finalizes numerous policies related to navigators and other consumer assisters, changes in premium stabilization programs, the Small Business Health Options Program (SHOP), formulary exceptions, and improving quality standards, among various other standards. The most notable standards relate to how enrollees may request access to non-formulary drugs under exigent circumstances. In 2015 all ACA-compliant health plans in the individual and small group markets are required to have an accelerated exceptions process where enrollees can gain access to non-formulary drugs under situations where an enrollee’s life, health, or ability to regain maximum function are threatened or the enrollee is undergoing a current course of treatment for a non-formulary drug.READ MORE »