December 4, 2020
In Part 1 of this article, we introduced Medicare and its covered services, along with rationales for digital health startups to engage with the nation’s largest payer. These motivations include Medicare’s large and growing beneficiary base, access to the nation’s largest and most influential payer, and movement toward value-based care.
Despite these opportunities, startups have been relatively...
November 24, 2020
Despite its attractive large market size, Medicare has long frustrated early stage healthcare companies. The complex federal health insurance system, mired in statutory constraints, has arguably discouraged entry from would-be external innovators.
Regulations intended to prevent fraud, waste, and abuse, also create barriers to adoption for innovative value-creating products and services. The goal...
May 9, 2019
Physician Compare, a CMS-operated website mandated by the Affordable Care Act, isn't providing a whole lot of information on most doctors, according to a research letter in JAMA Internal Medicine. Researchers from the University of Michigan used statistical software to estimate the quality and quantity of data available on the platform based on a sample of more than a million physician profiles...
April 30, 2019
The Centers for Medicare and Medicare Services has recognized chronic disease management company Livongo as an enrolled provider for Medicare Advantage members, the startup announced this morning in a release.
And, to kick off its new designation, Livongo’s diabetes management offering will be available this June to Medicare Advantage members receiving care through a Cambia Health Solution...
January 28, 2019
The Centers for Medicare and Medicaid Services have launched its first-ever patient-facing app. Called “What’s Covered”, the app will allow people covered by Original Medicare (that is, not Medicare Advantage) to search for particular medical products or procedures and see if they are covered.
The app is easy to use, with no sign-in required. It's part of a broader initiative called eMedicare...
December 5, 2018
For Brian Scarpelli, senior policy council at ACT | The App Association, it’s hard to overstate the changes coming to Medicare next month when it comes to telehealth and remote patient monitoring.
“Finally, after all these years, the Medicare system as of January 2019 is actually providing reasonable payment to physicians and other caregivers who are delivering care to Medicare beneficiaries, for...
November 1, 2018
The Centers for Medicare and Medicaid Services has locked in a rule that will allow home health agencies to report the cost of remote patient monitoring for reimbursement under Medicare. According to the announcement, released yesterday, this rule will be implemented in 2020.
Alongside this change also came others regarding payment and safety standards for qualified home infusion therapy...
June 13, 2018
The Centers for Medicare and Medicaid Services will reverse a longstanding unpopular position on reimbursement for smartphone-connected continuous glucose monitors, CMS announced yesterday.
"CMS heard from numerous stakeholders who shared their concerns that Medicare’s CGM coverage policy limited their use of CGMs in conjunction with their smartphones, preventing them from sharing data with...
April 17, 2018
Medicare reimbursement for telehealth services is notoriously patchy. Much to the chagrin of telehealth vendors and healthcare providers, and despite many attempts to change the status quo through legislation, CMS still has a lot of restrictions on the geography of users and provider (rural versus urban, at home versus at a clinic, etc.) and on the technology used (video is reimburseable, for...
September 26, 2017
Last week, Centers for Medicare and Medicaid Services Administrator Seema Verma revealed — in a Wall Street Journal editorial and an informal request for information (RFI) — that CMS would be heading in a “new direction” with the Center for Medicare and Medicaid Innovation (CMMI).
Primarily, Verma’s CMS seems interested in dropping the mandatory adoption of new payment methods in favor of a...