YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). For Medicare, this typically includes IPPS and OPPS.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

MRO Compliance

OCTOBER 23, 2023

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). These organizations received concessions from CMS to serve as early adopters and test the system.

Payment Systems 130

Payment Systems Medicare Medicare 130

Hall Render

AUGUST 1, 2022

The proposed payment policies include an initial monthly facility fee of approximately $268,000 per month, which will adjust in future years based on a market-basket update. REHs would also get a 5 percent add-on to most outpatient payments. Proposed REH Payments. 5 Percent OPPS Increase. million per year) for 2023.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Hall Render

AUGUST 10, 2023

In doing so, CMS will finalize changes to its rural floor wage index policy that can drastically change payments for certain hospitals and its extension of the wage index add-on for low-wage hospitals. CMS also uses the hospital wage index for the Outpatient Prospective Payment System. percentage points.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Hall Render

JULY 7, 2022

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”). The Proposed Rule did not contain the details of the payment policies for REHs, which CMS will develop in separate notice and comment rulemaking.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

Hall Render

MARCH 20, 2024

The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive Payment System.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. MACRA (2015): The Medicare Access and CHIP Reauthorization Act (MACRA) introduced the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Hall Render

APRIL 18, 2023

Background The Medicare Hospital Inpatient Prospective Payment System (“IPPS”) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment.

Medicare 40

Medicare Medicare Hospitals Payment Systems 40

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. One notable difference, however, is that the entity must enroll in Medicare as an REH. Background.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Hall Render

MARCH 1, 2023

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.

Hospitals 40

Hospitals Payment Systems Nurses Medical Device Industry 40

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

Hall Render

APRIL 20, 2022

The release of the Proposed Rule and the accompanying tables also triggers the start to several deadlines for hospitals, including the unofficial start of the Medicare Geographic Classification Review Board (“MGCRB”) application process. The Medicare program also has an “in between” status called “Lugar status.” Background.

Medicare 40

Medicare Medicare Hospitals Payment Systems 40

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment.

Medicare 52

Medicare Medicare Payment Systems Governance 52

Health Blawg

JULY 2, 2018

Joe has a couple of books out, is an active blogger at The cHealth Blog , and chairs the Connected Health conference. Some of these payment systems will work better for certain types of providers.). Joe anticipates having a CMS decision on whether to adopt these codes for Medicare payment purposes in time for January 2019.

Payment Systems 60

Payment Systems Electronic Medical Records Medicare Medicare 60

Health Blawg

JULY 2, 2018

Joe has a couple of books out, is an active blogger at The cHealth Blog , and chairs the Connected Health conference. Some of these payment systems will work better for certain types of providers.). Joe anticipates having a CMS decision on whether to adopt these codes for Medicare payment purposes in time for January 2019.

Payment Systems 60

Payment Systems Electronic Medical Records Medicare Medicare 60

Health Blawg

JULY 2, 2018

Joe has a couple of books out, is an active blogger at The cHealth Blog , and chairs the Connected Health conference. Some of these payment systems will work better for certain types of providers.). Joe anticipates having a CMS decision on whether to adopt these codes for Medicare payment purposes in time for January 2019.

Payment Systems 60

Payment Systems Electronic Medical Records Medicare Medicare 60

Health Blawg

JULY 2, 2018

Joe has a couple of books out, is an active blogger at The cHealth Blog , and chairs the Connected Health conference. Some of these payment systems will work better for certain types of providers.). Joe anticipates having a CMS decision on whether to adopt these codes for Medicare payment purposes in time for January 2019.

Payment Systems 60

Payment Systems Electronic Medical Records Medicare Medicare 60

Health Blawg

JULY 2, 2018

Joe has a couple of books out, is an active blogger at The cHealth Blog , and chairs the Connected Health conference. Some of these payment systems will work better for certain types of providers.). Joe anticipates having a CMS decision on whether to adopt these codes for Medicare payment purposes in time for January 2019.

Payment Systems 60

Payment Systems Electronic Medical Records Medicare Medicare 60

Healthcare Law Blog

JUNE 20, 2022

Nevertheless, on January 1, 2019, HHS effectuated its 2019 Outpatient Prospective Payment System rule, which continued the 340B Program cuts first implemented in the prior year, and expanded them to additional hospital locations. Instead, HHS appealed the District Court decisions to the U.S.

Hospitals 52

Hospitals Payment Systems Medicare Medicare 52

Hall Render

MAY 2, 2023

The CMS Memo provides that this means that all new SNF stays beginning on or after May 12, 2023 will require a qualifying hospital stay before Medicare coverage. Hall Render blog posts and articles are intended for informational purposes only. The F-Tag associated with this regulation is F-884. Benefit Period Blanket Waiver.

Nursing Homes 40

Nursing Homes Public Health Nurses COVID-19 40

Health Care Law Brief

NOVEMBER 17, 2021

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rules for the 2022 Medicare Physician Fee Schedule (PFS Final Rule) and 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS Final Rule). 77492 (Dec.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS recognizes a need to smooth these transitions and help to ensure stability in Medicare payments.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. CMS is finalizing this proposal. Deactivation.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Hall Render

JULY 12, 2022

Under the voluntary EOM model, Physician Group Practices (“PGPs”) will be accountable for their patients’ health care quality and total spend during six-month episodes of care for Medicare patients with breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma and prostate cancer.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Hall Render

MARCH 28, 2023

Blanket Waivers During the PHE, the Centers for Medicare & Medicaid Services (“CMS”) issued many versions and revisions to its memorandum entitled “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers” that announced blanket waivers for providers, including SNFs. When the PHE ends, the hotlines will be shut down.

Public Health 40

Public Health Nurses Nursing Homes COVID-19 40