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2024 Medicare Physician Fee Schedule Final Rule Makes Changes to Medicare Shared Savings Program

Hall Render

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024. CMS anticipates the changes will increase MSSP participation by 10% to 20%.

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CMS Issues Long-Awaited Medicare Advantage RADV Final Rule

Healthcare Law Blog

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology.

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New Marketing Possibilities for Vendors Contracted with Medicare Providers and Suppliers Following OIG’s Favorable Advisory Opinion on Limited Referral Bonuses

Healthcare Law Blog

On December 28, 2023, the Office of Inspector General (the “OIG”) issued a favorable Advisory Opinion (No. workflow and performance assessment, data analytics, and certain Medicare eligibility and performance assistance). On December 28, 2023, the Office of Inspector General (the “OIG”) issued a favorable Advisory Opinion (No.

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2023 Deadline for Physicians, Advanced Practice Providers and Teaching Hospitals to Review Sunshine Act Data Approaching

Hall Render

Following this reporting, impacted providers and teaching hospitals will have until May 15, 2023, to review reported payments and investments and to dispute any incorrect reports. During the Dispute Period, Covered Recipients may use CMS’ Open Payments system to formally dispute any information they believe is incorrect.

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CMS Releases FFY 2023 Proposed Rule; Proposed Cap on Wage Index Decreases & Wage Index Deadlines

Hall Render

The FFY 2023 IPPS Proposed Rule (“Proposed Rule”) was released on April 18, 2022, and CMS published the associated tables on its website. Further, Social Security Act Section 1886(d)(3)(E) requires that the standardized amount be adjusted for differences in hospital wage levels, which CMS implemented through the wage index system.

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ACOs prepare for eCQM quality reporting

MRO Compliance

This transformation aims to enhance patient care quality and better align ACO reporting with the Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS). Reporting via eCQM is optional in 2023 and 2024, but it becomes mandatory in 2025. Therefore, it is essential for ACOs to use their time wisely.

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CMS Proposes Regulations for Rural Emergency Hospital CoPs and CAH Updates; Providers Wait for Clarification on Payment Policies

Hall Render

The Consolidated Appropriations Act, 2021 (the “Act”) signed into law on December 27, 2020, created a new Medicare provider type called a Rural Emergency Hospital (“REH”). Critical access hospitals (“CAHs”) and rural hospitals with 50 beds or fewer could transition to REH status starting January 1, 2023. CAH Proposed CoPs.