Medicare Advantage rule change

[pmrmd]

At least it’s a start. These guys have been performing shamefully since Day 1.

Final Rule Makes Important Changes to Medicare Advantage and Part D - Medicare Rights Center

This week, the Centers for Medicare & Medicaid Services (CMS) finalized proposed policy changes to Medicare Advantage (MA) and Part D that may improve equity, access to care, and information for people with Medicare. At Medicare Rights, our comments were largely supportive, and we are glad to...

www.medicarerights.org

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[Multimodal]

In this day and age of doom and gloom for our profession, I'm happy there are still slivers of some good news out there. I'm curious to see what the insurance companies do to offset the loss from having to cover more services (cut doc pay vs increase premiums).

 

[Agast]

I’m not sure what’s actually going to change for pain management

The two instances I can think of (genicular nerve ablation, Vertiflex spacer) are not addressed by national or local coverage determination by Medicare. That means Medicare advantage can continue to make internal policies to deny them.

Payment by Medicare for services does not technically mean coverage

 

[Ducttape]

so...

all the genicular RFAs are being denied by Excellus, because they changed LCDs.

anyone else come to this conundrum?

and in truth, the L36850 does not specify anything about RFA - it is global discussing any peripheral nerve block.