Enlarge (credit: Getty | YinYang )

In a disturbing sign of the times, Medicare this week implemented a change to its claims-processing system that adds two extra digits to money amounts, expanding the fields from eight digits to 10. The change now allows for billing and payment totals of up to $99,999,999.99, or a penny shy of $100 million.

In a notice released last month, the Centers for Medicare & Medicaid Services (CMS) explained the change, writing, "With the increase of Part B procedures/treatments exceeding the $999,999.99 limitation, CMS is implementing the expansion of display screens for monetary amount fields related to billing and payment within [the Fiscal Intermediary Shared System (FISS)] to accept and process up to 10 digits ($99,999,999.99)"

The FISS is the processing system used by hospitals and doctors' offices to process Medicare claims.

Enlarge / A nursing home resident is pushed along a corridor by a nurse. (credit: Getty | Marijan Murat )

Health insurance companies cannot use algorithms or artificial intelligence to determine care or deny coverage to members on Medicare Advantage plans, the Centers for Medicare & Medicaid Services (CMS) clarified in a memo sent to all Medicare Advantage insurers .

The memo—formatted like an FAQ on Medicare Advantage (MA) plan rules—comes just months after patients filed lawsuits claiming that UnitedHealth and Humana have been using a deeply flawed, AI-powered tool to deny care to elderly patients on MA plans. The lawsuits, which seek class-action status, center on the same AI tool, called nH Predict, used by both insurers and developed by NaviHealth, a UnitedHealth subsidiary.

According to the lawsuits, nH Predict produces draconian estimates for how long a patient will need post-acute care in facilities like skilled nursing homes and rehabilitation centers after an acute injury, illness, or event, like a fall or a stroke. And NaviHealth employees face discipline for deviating from the estimates, even though they often don't match prescribing physicians' recommendations or Medicare coverage rules. For instance, while MA plans typically provide up to 100 days of covered care in a nursing home after a three-day hospital stay, using nH Predict, patients on UnitedHealth's MA plan rarely stay in nursing homes for more than 14 days before receiving payment denials, the lawsuits allege.

Enlarge (credit: Getty | YinYang )

The first 10 prescription drugs up for Medicare price negotiations have had years of price hikes that have ratcheted up costs for US taxpayers—which totaled $50.5 billion in gross Medicare Part D coverage costs in the past year and $3.4 billion in out-of-pocket costs in 2022.

Today, the Department of Health and Human Services announced the 10 drugs selected for the first round of Medicare price negotiations, established under the Inflation Reduction Act. All but one of the announced drugs were among the top 25 costliest Medicare Part D prescriptions in 2021. An analysis by the AARP released earlier this month found that those top 25 drugs had price increases that, on average, tripled their list prices in their time on the market and far exceeded the rate of inflation.

The 10 selected today were no exception. The drugs are used by about 9 million Medicare Part D enrollees and treat various conditions, from diabetes, psoriasis, blood clots, heart failure, chronic kidney disease, to blood cancers. Based on 2021 prices, the nine drugs included in the AARP analysis were found to have list price increases averaging 262 percent in their time on the market. The average corresponding rate of inflation for the nine drugs was 64 percent.

What's your url? mine is: https://hub.libranet.de/channel/paulfree14

#hubzilla is a federated #cms (#wiki, #forum #webpage #cloud

But the best part is that it comes with #nomadicidentity Which means you are not bond an instance You can travel around instances and always take your friends and followers with you

By that no admin will have the power of breaking the connection between you and followers. All the power is in your hands

#hubzilla