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Red Tape Roadblocks - Two Physicians Can Barely Get P.A. Drug for Very Sick...
In an essay in Annals of INternal Medicine, dated 1/21/2025, two physicians can barely, after weeks of effort, get a key drug for their very sick child. The denials were repetitive and had to do with...
View ArticleMissing Essay on "What to say" in the most difficult situations
Some in 2024, I think in mid-2024, I saw an essay by a physician in one of the major journals (I think. I think, JAMA or NEJM or Ann Intern Med, etc).The essay was about what to say in difficult...
View ArticleDo 2022 and 2024 OIG AO on Drug Genetic Testing Contradict each other?
January 6, 2025, Dark Report reviews 2024 and cites a July 2024 op ed in STAT about the DOJ's retrograde attitude toward pharma-supporting genetic testing for drug eligibility. I asked Chat GPT 4...
View ArticleWaivers 1115 (Medicaid, old), 1115A (Medicare, 2010 ACA), 1332 (State...
The health plan waivers under Sections 1115, 1115A, and 1332 of the Social Security Act (SSA) and Affordable Care Act (ACA) serve distinct purposes and apply to different areas of healthcare policy....
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Finding New MOLDX LCDs over Several years
You can get a report of Final LCDs at the Medicare Coverage Database.https://www.cms.gov/medicare-coverage-database/search.aspxGo to function REPORTS.Although I may have missed some automatic online...
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MOLDX STATE COUNT = 28
MOLDX STATE COUNTNORIDIANJE -3JF - AK WA OR ID MT (5) plus 5 border states = 10WPS 4, 2, = 6CGS = 2PALM = 4+ 3 = 713, 8, 7, 21, 7, 28
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Alternate picture L39367 (L39365)
###Chat GPT assesses my 1-28-2025 blogYour blog does a great job of dissecting the Novitas LCD with both sharp analysis and an undercurrent of exasperation that fits the absurdity of the situation....
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Was there an Oncotype case based on surgeon test orders? I can't find one.
Beginning in around 2008, Medicare covered the Oncotype Dx test, a breast cancer molecular prognostic test used for decisions about cancer management after an initial resection (lumpectomy). I believe...
View ArticleSidebar: CMS and Rhode Island (re: RFK Day 1)
What's Senator Whitehouse saying about "payment disparities in Rhode Island?" Surely there are no specific policies designed to be adverse to Rhode Island. Senator Sheldon Whitehouse (D-RI) raised...
View ArticleUpdate to OPPS System for Radiopharma > $650
Find it here:https://www.cms.gov/files/document/r13032cp.pdf
View ArticleCCLA Notes mrd etc
9-18-24 MolDX: Definition of Patients With and without Cancer [Bruce Quinn – Bruce Quinn & Associates] Could MolDX please revisit its definitions of patients with cancer and patients without...
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Chat GPT and Medicare Policy: Balance Billing, Concierge, Medicare Advantage...
This is a historical question about the Medicare program for physicians, when did the Medicare part b program stop allowing balance billing? I think it might’ve been in the 1980s or 1990s, however, I...
View ArticleMy Encounter with RFK Jr; Radical Ideas for HHS Innovation?
Ok, I did not have a "meeting" with RFK Jr, but we did have an "encounter" - said hello to each other on a flight from Washington to LAX on Friday. Interestingly, this led me to four or five ideas...
View ArticleRichardson Waiver 1971
Office of the SecretaryPUBLIC PARTICIPATION IN RULE MAKINGStatement of PolicyNotice is hereby given of a statement of policy on public participation in rule making issued by the Secretary. As a matter...
View ArticleMeans Testing Medicare (Letter)
"Means Testing Medicare" WSJhttps://www.wsj.com/opinion/means-testing-medicare-would-do-no-harm-spending-rich-healthcare-d48a7441BQ:Means-testing Medicare is much odder than this indicates, and I'm...
View ArticlePMC Letters
UHC on PGX Panelshttps://www.personalizedmedicinecoalition.org/wp-content/uploads/2024/12/letter.pdfAHRQ on MCED...
View ArticleChat GPT summarizes Hernan' on target trials
See original paper.https://www.acpjournals.org/doi/epdf/10.7326/ANNALS-24-01871See my blog on the paper:https://www.discoveriesinhealthpolicy.com/2025/03/cms-releases-ncd-proposals-with-ced.htmlChat...
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JAMA DEI etc list
Measles, Mumps, Rubella, Hviid et al., 2019 Ann Intern Med ###https://journalofethics.ama-assn.org/article/living-histories-structural-racism-and-organized-medicine/2021-12AMA Journal of Ethics Dec...
View ArticleAquablationi links
[Conflicts of interest in scientific publications and possible consequences : A critical analysis using the example of benign prostatic hyperplasia (BPH)].Herrmann J, Netsch C.Urologie. 2025 Mar 10....
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Robert Boorstein on challenges of local NGS
https://www.linkedin.com/posts/robert-boorstein-aa74931_illuminas-push-to-democratize-genomics-with-activity-7311839487347572736-z2c0/ ROBERT BOORSTEINAt the end of 2024, low throughput instruments...
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IGENOMICS New PLA Codes (April 2025)
I did not really understand these new PLA codes. I can't vouch for whether Chat GPT is explaining them right. It is certainly trying to explain them.CHAT GPT SAYS:Explanation in Clinical Terms...
View ArticleSignatera Pivotal LUNG studies
https://www.natera.com/company/news/natera-announces-medicare-coverage-of-signatera-for-surveillance-in-lung-cancer/Abbosh C, Birkbak NJ, Wilson GA, et al. Phylogenetic ctDNA analysis depicts...
View ArticleAI Reviews Impact of FDA-LDT Case on CMS Policies for FDA Lab Tests
Pure Chat GPT. offered FYI only.#####Here are some of the questions among NGS policy nerds, since the Texas court "loss" for the FDA LDT rule on March 31.(1) What happens to updates of lab-based FDA...
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