As a personal consumer of healthcare, you may be quite familiar with your Pharmacy Benefit Manager (PBM). When going to the pharmacy to pick up your prescription (Part D) drug, in order to have your your prescription covered by insurance you are asked to provide proof...
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare medical claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary...
As described by the Centers for Medicare and Medicaid Services (CMS), the Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare...
Beginning January 1, 2022, CMS increased the penalty for some hospitals that do not comply with the Hospital Price Transparency final rule. However, it has been noted that thousands of hospitals are not in compliance. Click here to learn more.
Finding the Healthcare Common Procedure Coding System (HCPCS) code for a new product or drug is easier than you may think! The Centers for Medicare & Medicaid Services (CMS) publishes an updated National Drug Code (NDC)/HCPCS crosswalk file every quarter. You can...
Since 2020, the Centers for Medicare & Medicaid Services (CMS) has been reviewing Healthcare Common Procedure Coding System (HCPCS) applications quarterly and posting their decisions with explanations on their website. To access the HCPCS application summaries,...
