While You Watched The Shooting, Medicare Payment Policies Got Updated

Federal Register update 12/9/2024

Conspiracy Sarah

Dec 09, 2024

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For the record, this is how many tabs I currently have open 😂

The fuckery is so deep. And so wide.

When the CEO of a health “care” monopoly was “murdered”, on camera, with every news site in the land reporting diligently and to the exclusion of all else, I knew that I should be looking elsewhere.

I immediately looked to the obvious open DOJ investigations (including some medicare fraud), and the impending lawsuit over the largest data leak ever. But these are obvious.

BREAKING: UnitedHealthcare (Change Healthcare) CEO Shot Ahead of Possibly the Largest Data Breach Settlement in History

Conspiracy Sarah

December 5, 2024

Read full story

It’s holiday season, which means it’s Federal Register Sneak Shit In Season. So today I decided to look at the recent Federal Register updates. I started with the day Brian Thompson was shot, and worked through last week. After spending the better part of today looking at last week (and there’s plenty), I happened to click on tomorrow; Monday, December 9, 2024, which was surprisingly already there.

Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments

This is a BEAST of a document and I certainly haven’t combed through the whole thing. It’s 1,348 pages.

I already had my eye on the Federal Register because Covid is officially still an emergency through December 24, 2024, despite what you may have heard, 👇

The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to update the determination of a public health emergency and clarify the disease threat, add two new limitations on distribution, extend the time period of coverage for certain Covered Countermeasures and Covered Persons, clarify the time period of coverage for Covered Persons authorized under the Declaration, extend the duration of the Declaration to December 31, 2024, and to republish the Declaration in full. (read in full here)

This is when they like to put things through. When everyone is busy with the holidays and their families. Schedules are different, kids are out of school...nobody is paying attention.

The updated medicare rule caught my eye because I was looking at the Federal Register as it relates to the United Healthcare Theatre and a current lawsuit. But the payment policies and physician fee schedule applies more broadly, and I thought I’d share it.

The “covid” “emergency” (EUA) could be ending as soon as December 24, 2024 (still yet to be seen). I don’t know about you, but I think a backup jab campaign would be a good idea. Just to make sure shots in arms compliance doesn’t decline. Especially with the olds. We’ve gotta balance that social security issue after all. It sure would be helpful if we could make sure that the doctors are still getting paid to put zeeee shots into zeeeee arms. I mean, if the EUA for “covid” disappears, that’ll be a real income adjustment for some docs. Anywho….

What to do?!?!?

1. Revise the regulations, of course!

In section III.M. of this rule, we are finalizing an expansion of hepatitis B vaccine coverage by revising existing regulations. In this section of the rule, we clarify that a physician's order is no longer required for the administration of a hepatitis B vaccine in Part B, which will facilitate roster billing by mass immunizers for hepatitis B vaccine administration. We are also finalizing a policy to set payment for hepatitis B vaccines and their administration at 100 percent of reasonable cost in RHCs and FQHCs, separate from the FQHC PPS or the RHC All-Inclusive Rate (AIR) methodology, to streamline payment for all Part B vaccines in those settings.

2. Expand the list of people who are at high or intermediate risk! Add some new paragraphs. Duh.

2. Revised Payment Policies for Hepatitis B Vaccine Administration

In section III.M of this final rule, we are finalizing our proposal to expand the list of individuals who are determined to be at high or intermediate risk of contracting hepatitis B at § 410.63 in order to improve access and utilization of hepatitis B vaccines. Specifically, we proposed to expand coverage of hepatitis B vaccinations by revising § 410.63(a)(2), Intermediate Risk Groups, by adding a new paragraph (a)(2)(iv) to include individuals who have not previously received a completed hepatitis B vaccination series and individuals whose previous vaccination history is unknown. We believe that this final rule coverage change will help protect Medicare beneficiaries from acquiring hepatitis B infection, contribute to eliminating viral hepatitis as a public health threat in the United States, and is in the best interest of the Medicare program and its beneficiaries. Below, we discuss how the proposal to expand coverage may impact Part B payment policy for hepatitis B vaccines and administration.

3. Get rid of doctor’s orders.

What does he know anyway. Fuck it. JAB THE OLDS.

b. Revisions to Payment Policies for Hepatitis B Vaccinations

As discussed above, in section III.M of this final rule, we are finalizing a policy to provide coverage under Part B for hepatitis B vaccines and their administration for an expanded range of Medicare enrollees, as reflected in the revised § 410.63(a). We explain that Medicare coverage of hepatitis B vaccination is outdated in light of recent information about the risks of contracting hepatitis B, and that current research indicates that individuals who remain unvaccinated against hepatitis B are at intermediate risk of contracting hepatitis B virus. Under the new policy, an assessment of an individual's vaccination status can now be made without the clinical expertise of a physician. Thus, we will remove our policy in the manual that the administration of a Part B-covered hepatitis B vaccine be preceded by a doctor's order. A doctor's order will no longer be necessary for the administration of a hepatitis B vaccine under Part B, and we will also change our procedures to allow mass immunizers to use the roster billing process to submit Medicare Part B claims for hepatitis B vaccines and their administration

Get to the good stuff already.

What’s the payout?

We note that the current payment rates for HCPCS code G0010, “ Administration of hepatitis b vaccine, ” as finalized in the CY 2024 PFS final rule, can be found on the CMS Vaccine Pricing website under “Seasonal Flu Vaccines”.^[]The payment rates for G0010, with the annual update applied for CY 2025, are available in Tables 51 and 52 in section III.H.1.f. of this final rule. More information on other policies related to the administration of G0010 can be found in the section preceding this one (section III.H.1. of this final rule), and revisions to payment policies for the administration of G0010 in RHCs and FQHCs can be found in the section immediately below (section III.H.2.c. of this final rule).

What does that $$ look like?

Let’s just say that I’m a doctor and I vaccinate 6 patients per day for Hep B.

Day: 6 x 33.71 = $202.26
Week: 202.26 x 5 = $1011.30
Month: 1011.30 x 4 = $4,045.20
Year: 4045.20 x 12 = $48,542.40

Hey…almost as good as “covid” jab money!

Fun “Facts”

People supposedly at risk for Hep B:

Health care providers and emergency responders
Sexually active individuals (more than 1 partner in the past six months)
Men who have sex with men
Individuals diagnosed with a sexually transmitted disease
Illicit drug users (injecting, inhaling, snorting, pill popping)
Sexual partners or those living in close household contact with an infected person
Individuals born in countries where hepatitis B is common (Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East)
Individuals born to parents who have emigrated from countries where hepatitis B is common (see #7)
Children adopted from countries where hepatitis B is common (see #7)
Adoptive families of children from countries where hepatitis B is common (see #7)
Anyone diagnosed with cancer prior to initiation of anticancer treatment
Kidney dialysis patients and those in early kidney (renal) failure
Inmates and staff of a correctional facility
Residents and staff of facilities for developmentally disabled persons
ALL pregnant women