Medicaid Enrollees Struggle to Receive Psychiatric Care
HCPLive
AUGUST 5, 2024
In a "secret shopper" study, investigators posing as Medicaid enrollees found many clinicians in Medicaid provider directories do not accept Medicaid insurance.
Medicaid Related Topics 
Medicaid Might Cut Cardiovascular Risk for This One Group
Med Page Today
SEPTEMBER 24, 2024
(MedPage Today) -- Getting onto Medicaid might not improve cardiovascular risk factors universally, but it did for some individuals, as secondary analysis of a randomized trial showed. Previously uninsured, low-income individuals who won a lottery.
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Extending Postpartum Medicaid Linked to Increased Perinatal Mental Health Care
HCPLive
APRIL 12, 2024
A new study found extending postpartum Medicaid from 60 days to 12 months is linked to new mothers being more likely to seek mental health care for perinatal mood and anxiety disorders.
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DAA Use Increased After State Medicaid Programs Eased HCV Treatment Restrictions
HCPLive
APRIL 18, 2024
The modified difference-in-differences analysis found notable increases in DAA use after state Medicaid programs relaxed certain coverage restrictions.
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Despite Acceptance of Medicaid by Pediatric Dermatologists, Access Issues Remain
HCPLive
JULY 1, 2024
These data suggest differences in Medicaid-accepting pediatric dermatologist access based on such factors as geographic area and density of pediatric dermatologists per county.
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Medicaid Often Restricts Access to Heart-Protective Diabetes Agents
Med Page Today
APRIL 21, 2025
(MedPage Today) -- Medicaid plans often put up barriers around newer classes of diabetes medications that offer cardioprotection, according to a national study of formulary policies as of March 2024. Mainly driven by restrictive formulary policies.
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Medicaid Expansion and Healthcare Workers; Cardiac Rehabilitation
Med Page Today
MARCH 2, 2024
(MedPage Today) -- TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center.
Medicaid Status May Worsen Complications After Heart Transplantation
HCPLive
JANUARY 26, 2025
Medicaid-insured heart transplant recipients reported worse survival and higher risk of cardiac allograft vasculopathy over 5 years.
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Medicaid Direct-Acting Antiviral Restrictions Linked to Reduced HCV Treatment Rates
HCPLive
JULY 17, 2024
The cross-sectional analysis found Medicaid nonexpansion status, fibrosis, and sobriety restrictions negatively impacted annual rates of DAA prescription fills.
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Medicare Will Cover Blood Tests to Monitor for Transplant Rejection, for Now
Med Page Today
DECEMBER 27, 2024
(MedPage Today) -- In August, we reported on the decision by the Centers for Medicare & Medicaid Services (CMS) to not pursue a proposed Medicare policy that would have restricted coverage of a blood test used to monitor for transplant rejection.
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Heart Disease Outcomes Better When Anxiety, Depression Are Treated
Med Page Today
MARCH 21, 2024
(MedPage Today) -- In people with heart disease and comorbid anxiety or depression, mental health treatment showed strong links to better clinical outcomes in an observational analysis of the Ohio Medicaid database. Those hospitalized with coronary.
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CMS Releases 2025 Medicare Physician Fee Schedule and Hospital OPPS Final Rules
American College of Cardiology
NOVEMBER 1, 2024
The Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (PFS) final rule and the 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule on Nov. Of note, the 2025 PFS conversion factor is $32.3465, a reduction of 2.83% from $33.2875 in 2024.
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Abstract 4119868: Statin and PCSK9 Inhibitor Utilization and Spending in Medicaid between 2018 to 2022: A National Analysis
Circulation
NOVEMBER 11, 2024
Introduction:Low-income working-aged adults in the Medicaid program have a high burden of cardiovascular risk factors and disease, but often face barriers accessing necessary therapies. However, Medicaid spending on statins decreased by 7.1%, from $246.2 million statin prescriptions in 2018 compared to 20.3 million to $226.8
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Industry marketing payments to physicians and prescription patterns for sacubitril/valsartan in the USA
Heart BMJ
JANUARY 29, 2025
Methods Using the publicly accessible Centers for Medicare and Medicaid Services Medicare Part D database and the Open Payments Database, this study assessed associations between industry-sponsored meal payments to physician prescribers and total amounts of Medicare claims and spending for sacubitril/valsartan between 2015 and 2021.
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New Tool Helps Predict Stroke Outcome with Higher Accuracy
DAIC
JANUARY 30, 2025
This model aligns with the 2025 Centers for Medicare & Medicaid Services (CMS) initiatives, including value-based care and age-friendly health system measures, while supporting our mission to deliver improved outcomes and quality care for every patient."
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Life After Change Cyber-attack: Without Payment for Claims, Physicians Struggle to Keep Practices Afloat
DAIC
APRIL 10, 2024
Respondents have received assistance from the Centers for Medicare & Medicaid Services (12 percent), state Medicaid plans (0.7 In addition to dipping into personal funds, respondents did report taking advantage of advance payments, temporary funding assistance, and loans.
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Health and Hope for Everyone, Everywhere, Starts With Access to Health Care: The Role of Medicaid Expansion
Circulation
JUNE 30, 2024
Circulation, Volume 150, Issue 1 , Page e1-e2, July 2, 2024.
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CMS Pauses AUC Program For Advanced Diagnostic Imaging, Rescinds Current Regulations
American College of Cardiology
DECEMBER 14, 2023
The Centers for Medicare and Medicaid Services (CMS) has paused the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging and rescinded any current regulations, according to the 2024 Medicare Physician Fee Schedule (PFS) final rule.
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Blood-Based Colorectal Cancer Screening Projected to Fall Short Compared to FIT, Colonoscopy
HCPLive
MARCH 26, 2024
A hypothetical triennial blood-based screening test meeting Centers for Medicare and Medicaid Services coverage criteria was cost-effective versus no screening but not compared to FIT, sDNA-FIT, or colonoscopy.
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CMS to cover implantable heart failure device
Becker's Hospital Review - Cardiology
JANUARY 13, 2025
"CMS proposes Medicare and Medicaid coverage for implantable pulmonary artery pressure sensors to manage heart failure. Final decision to be published on Jan.
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Stephen Congly, MD: Impact of Generic Nucelos(t)ide Analogues on HBV Treatment Spending
HCPLive
JUNE 10, 2024
Congly explains key findings from his cross-sectional study of costs associated with HBV treatment in patients on Medicaid and the economic impact of generic versus originator use.
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Medicare for Renal Denervation; Cardiac Telemetry App Recall; Stroke Flags in Eyes
Med Page Today
JANUARY 14, 2025
(MedPage Today) -- The Centers for Medicare & Medicaid Services will review a potential national Medicare coverage policy for renal denervation for patients with hypertension, Medtronic announced. The FDA said Philips is recalling the monitoring.
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AUC Program Penalty Phase Suspended Indefinitely: We Answer Your Frequently Asked Questions
Cassling
JANUARY 10, 2023
UPDATE: The penalty phase of the Centers for Medicare & Medicaid Appropriate Use Criteria (AUC) program has been suspended until further notice. A major goal of the AUC is to help providers order the most appropriate test for their patients by using a Clinical Decision Support Mechanism (CDSM).
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CMS Releases FY 2026 IPPS Proposed Rule
American College of Cardiology
APRIL 17, 2025
The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule on April 11, proposing a net increase of 2.4% for inpatient hospital payments.
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CMS Releases Proposed 2025 Medicare Physician Fee Schedule and Hospital OPPS Rule
American College of Cardiology
JULY 10, 2024
The Centers for Medicare and Medicaid Services (CMS) has released the proposed 2025 Medicare Physician Fee Schedule (PFS). Of note, the PFS conversion factor has been updated from $33.2875 to $32.3562, a 2.80% cut.
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Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Florida Medicaid and Medicare Recipients in the OneFlorida+ Research Consortium
Hypertension Journal
JANUARY 16, 2024
Hypertension, Volume 81, Issue 2 , Page e7-e9, February 1, 2024.
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Depression Screening Rates during COVID-19 Low Among Telehealth Appointments
HCPLive
FEBRUARY 13, 2024
Telehealth appointments, patients who prefer speaking non-English, older adults, and patients on Medicaid had lower odds of having a depression screening during the early COVID-19 pandemic.
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HeartFlow AI Plaque Analysis Achieves Major Milestone Towards Medicare Coverage
DAIC
JUNE 4, 2024
HeartFlow’s accurate and actionable Plaque Analysis aligns with the Centers for Medicare & Medicaid Services (CMS) commitment to supporting technologies that enhance diagnostic accuracy and patient care: HeartFlow Plaque Analysis is the only FDA cleared plaque analysis with a reported 95% agreement prospectively compared to the gold standard, IVUS.¹
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104 Coding Corner: How to Use New ASCVD Risk Assessment and Management Codes
American College of Cardiology
JANUARY 3, 2025
The Centers for Medicare and Medicaid Services (CMS) created two new G codes in the 2025 Medicare Physician Fee Schedule final rule that will provide reimbursement for atherosclerotic cardiovascular disease (ASCVD) risk assessment and risk management services.
ACC 2025 Medicare Physician Fee Schedule Final Rule Calculator Now Available
American College of Cardiology
DECEMBER 2, 2024
Work, practice, expense and liability relative value units (RVUs) are updated annually through the Centers for Medicare and Medicaid Services' Medicare Physician Fee Schedule (PFS) rulemaking.
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ACC Submits Comments on 2025 Hospital OPPS Proposed Rule
American College of Cardiology
SEPTEMBER 5, 2024
The ACC submitted formal comments to the Centers for Medicare and Medicaid Services (CMS) on Sept. 4, providing feedback and raising concerns on several issues of relevance to the cardiovascular community in the 2025 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.
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ACC 2025 Medicare Physician Fee Schedule Proposed Rule Calculator Now Available
American College of Cardiology
JULY 31, 2024
Work, practice, expense and liability relative value units are updated annually through the Centers for Medicare and Medicaid Services’ Medicare Physician Fee Schedule (PFS) rulemaking.
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Highlights From the Proposed 2025 Hospital OPPS Rule
American College of Cardiology
JULY 18, 2024
The Centers for Medicare and Medicaid Services (CMS) released the proposed 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule on July 10. CMS proposes a 2.6% increase to OPPS payment rates that reflects a market basket update of 3.0%
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ACC Grassroots Drives Momentum For Federal Prior Auth Reform
American College of Cardiology
JULY 17, 2024
The legislation builds on regulatory action taken by the Centers for Medicare and Medicaid Services earlier this year, requiring the use of electronic prior authorization, tightening response timelines and updating transparency requirements. The Improving Seniors’ Timely Access to Care Act of 2024 (H.R.
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Proposed 2025 Medicare Physician Fee Schedule Deep Dive
American College of Cardiology
JULY 16, 2024
The Centers for Medicare and Medicaid Services (CMS) released the proposed 2025 Medicare Physician Fee Schedule (PFS) on July 10, addressing Medicare payment and quality provisions for physicians in the coming year. Under the proposal, physicians will see a decrease to the conversion factor of 2.80% on Jan.
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Heart of Health Policy | 2025 Medicare Physician Fee Schedule Final Rule: What CV Clinicians Need to Know
American College of Cardiology
DECEMBER 2, 2024
The Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (PFS) final rule on Nov. Of note, the 2025 PFS conversion factor is $32.3465, a reduction of 2.83% from $33.2875 in 2024.
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Lower Prices For Medicare Drug Negotiation Program’s First 10 Drugs Announced
American College of Cardiology
AUGUST 15, 2024
The Centers for Medicare and Medicaid Services (CMS) on Aug. 15 announced the results of price negotiations for the first 10 drugs selected for the Medicare Drug Negotiation Program, made possible by the passage of the Inflation Reduction Act in 2022.
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CMS Grants Distinct TPT Device Code and Category to Recor Medical for Ultrasound Renal Denervation
DAIC
NOVEMBER 8, 2024
Centers for Medicare & Medicaid Services (CMS) have granted the company’s Paradise Ultrasound Renal Denervation system a Transitional Pass-through (TPT) payment. tim.hodson Fri, 11/08/2024 - 09:57 Nov. 1, 2024 — Recor Medical, Inc. and its parent company, Otsuka Medical Devices Co. recently announced U.S.
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40 CMS Releases the FY 2025 IPPS Final Rule, Finalizes TEAM Program
American College of Cardiology
AUGUST 7, 2024
The Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2025 Inpatient Prospective Payment System (IPPS) Final Rule on Aug. 1, including a 2.9% increase in operating payment rates for general acute care hospitals, representing a 3.4% increase in the hospital market basket with a 0.5%
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Action Steps Following CCTA Coding Change From 2025 OPPS Final Rule
American College of Cardiology
JANUARY 8, 2025
The Centers for Medicare and Medicaid Services (CMS) has temporarily reassigned coronary CT angiography (CCTA) codes 75572-75574 from ambulatory payment classification (APC) 5571 to APC 5572 in the 2025 Outpatient Prospective Payment System (OPPS) final rule. in 2024 to $357.13 in 2025.
ACC Grassroots Efforts Usher in Major Prior Auth Win
American College of Cardiology
JANUARY 24, 2024
The final Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization (PA) Rule released this month marks a major milestone in reforming prior authorization practices and reflects the ongoing work of ACC Advocacy to reduce prior authorization burden on clinicians.
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ONC Releases HTI-2 Proposed Rule to Improve Health IT Interoperability, Update Standards For EHRs, More
American College of Cardiology
JULY 10, 2024
The Office of the National Coordinator for Health Information Technology (ONC) released on July 10 the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule, building on the HTI-1 final rule released in 2023 and additional information blocking rules released (..)
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CMS Seeks Feedback on Cardiac CT Billing and Payment
American College of Cardiology
AUGUST 22, 2024
The Centers for Medicare and Medicaid Services (CMS) summarized a recent billing edit change in the 2025 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, which fixes an issue that previously prevented hospitals from reporting costs for cardiac computed tomography (CT) as cardiology services.
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Trends in direct health care costs among US adults with atherosclerotic cardiovascular disease with and without diabetes
Cardiovascular Diabetology
JULY 7, 2024
The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).
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