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CAQH Study: Initial Results Show Pharmacy Administrative Transactions Are Highly Automated

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WASHINGTON, Dec. 15, 2020 /PRNewswire/ CAQH today released the first CAQH Pharmacy Services Index, a report that examines levels of automation among pharmacy benefit managers (PBMs) for three common administrative transactions. This initial research suggests that PBMs generally conduct a higher percentage of these transactions electronically than medical plans, likely due to different workflows, volumes and levels of transaction complexity.
The initial data indicates that PBM administrative transactions are generally more automated than similar medical transactions, but this is just the first step, said April Todd, CAQH Senior Vice President for CORE and Explorations. Based on these preliminary findings, we hope to expand our research to include providers and additional transactions to understand the differences in how administrative functions are conducted and to pinpoint opportunities for greater automation. ....

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CMS Issues 2021 MPFS and QPP Final Rule | Holland & Knight LLP

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The Centers for Medicare & Medicaid Services (CMS) has published the Calendar Year (CY) 2021 Final Rule for the Medicare Physician Fee Schedule (MPFS), which contains updates to the Quality Payment Program (QPP). The MPFS dictates Medicare rates and policies under Part B, while the QPP implements two value-based payment programs: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
Among notable changes, CMS has proposed to make permanent certain telehealth changes that have been implemented in response to the COVID-19 public health emergency (PHE), confirmed the evaluation and management (E/M) documentation guidelines and payment changes finalized in the 2020 MPFS, and delayed the MIPS Value Pathway (MVP) until the 2022 performance period or later. ....

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