In this all-new episode of Compliance Deconstructed, Jessica Zeff, Elvan Baker, and Lorie Davis unpack the major changes included in the latest Medicare Final Rule. From medication affordability to patient rights, the discussion centers on how these updates are poised to drive better health outcomes and increase clarity for healthcare providers and patients alike.

One major highlight is the new $35 cap on insulin costs for Medicare beneficiaries, offering a more predictable and affordable path for managing diabetes. This episode explores the real-world impact of this change, particularly for individuals who previously had to ration or delay life-saving medication due to cost.

Another key topic is the elimination of cost-sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). By removing deductibles and fees, Medicare is making preventive care more accessible - a change that can lead to higher vaccination rates and improved public health outcomes.

In addition, your hosts  also break down the new patient appeal rights related to hospital stay classifications under Medicare. These regulatory updates aim to protect beneficiaries from unexpected bills and support transparency in healthcare, making this one of the most impactful Medicare Final Rules in recent years for both patients and compliance professionals.

6 Key Takeaways

• The Medicare Final Rule now caps insulin costs at $35 or 25% of the negotiated price, making diabetes management more affordable.
• All ACIP-recommended adult vaccines are now covered by Medicare without deductibles or cost-sharing.
• Medicare beneficiaries can now appeal retrospective reclassifications of hospital stays from inpatient to outpatient or observation status.
• Healthcare organizations must update benefit plans, systems, and member communications to reflect these rule changes.
• Provider education is essential to ensure accurate documentation and compliance with new classification and billing standards.
• These updates reflect CMS’s broader commitment to improved access, affordability, and patient rights in the U.S. healthcare system.

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