CMS Innovation

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CMS to add prior authorization for traditional Medicare services - Becker's Hospital Review | Healthcare News & Analysis

CMS has unveiled the Wasteful and Inappropriate Service Reduction model, a new Innovation Center initiative that will add prior authorization for some traditional fee-for-service Medicare services. Under the model, CMS will partner with companies specializing in AI and machine learning to test...

www.beckershospitalreview.com

 

[OTN]

Full list of services included in the model:

Stimulator Services • Electrical Nerve Stimulators (NCD 160.7) • Sacral Nerve Stimulation for Urinary Incontinence (NCD 230.18) • Phrenic Nerve Stimulator (NCD 160.19) • Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease (NCD 160.24) • Vagus Nerve Stimulation (NCD 160.18) Induced Lesions of Nerve Tracts (NCD 160.1)

Epidural Steroid Injections for Pain Management (L39015, L39242, L36920) Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L34106, L38201, L35130) Cervical Fusion (L39741, L39762, L39793) Excluding codes already included in OPD Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee (NCD 150.9)

Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (L38307, L38312, L38385)

Incontinence Control Devices (NCD 230.10) Diagnosis and Treatment of Impotence (NCD 230.4)

Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis

(NCD 150.13) Skin and Tissue Substitutes • Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041) • Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities (L36690)

 

[Gfunk6]

AI based audits are being rolled out in all sectors, not just healthcare.

Hertz rental uses AI to "inspect" cars

AI is beautiful for corpos because;

1. It reduces the need for human capital
2. There is zero inherent subjectivity in the AI (just the "algorithm") although the AI can and will be programmed with biases to save the corpos money
3. Gives corpos plausible deniability when something bad happens - there is no longer a meatbag to take liability

 

[TheWallnerus]

(NCD 150.13) Skin and Tissue Substitutes • Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041) • Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities (L36690)

Multibillion-dollar healthcare fraud scheme included giving people 'unnecessary' skin grafts: DOJ

DOJ unveils charges in historic healthcare fraud operation targeting more than 300 defendants, including 25 doctors, who sought to cheat Medicare and other programs out of $14.6 billion.

www.foxnews.com