Tag: CMS

Hospitals to Assume Risk in Value-Based Care Models

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
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Coding CAR T Cancer Treatment Revolutionized

Coding CAR T: Cancer Treatment Revolutionized

Now that revolutionary cancer therapy, Chimeric Antigen Receptor T-cell (CAR T-cell), is covered, let’s take a look coding CAR T. Last month the Centers for Medicare & Medicaid Services (CMS) finalized the long-sought rules for coverage of CAR-T, novel cutting-edge, often curative treatments that utilize the patients’ own genetically modified immune cells to fight cancer. The […]
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ICD-10-PCS Changes

ICD-10-PCS Changes: 20 Codes Deleted For FY 2020

CMS has provided ICD-10-PCS updates for fiscal year 2020 that include 2,056 deletions. Here are 20 of the deleted codes: 0370046 – Dilation of right internal mammary artery, bifurcation, with drug-eluting intraluminal device, open approach 0372046 – Dilation of innominate artery, bifurcation, with drug-eluting intraluminal device, open approach 0374056 – Dilation of left subclavian artery, bifurcation, with […]
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CMS Fights Growing Number of Appeals

CMS Fights Growing Number of Appeals

Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted; decrease the number of appeals […]
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Understanding Why 99201 Will be Deleted

Understanding Why 99201 Will be Deleted

An overview of the proposed Medicare Physician Fee Schedule: The proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially released on Aug. 14, 2019, encompassing various elements. Among these are proposals such as adjusting the PFS conversion factor to $36.09, introducing new HCPCS codes for bundled episode-of-care treatment for opioid use disorders, revising […]
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CMS Proposes Changes to Physician Fee Schedule, Quality Payment Program

CMS Proposes Changes to Physician Fee Schedule, Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) is proposing changes to the Medicare Physician Fee Schedule (PFS) and the Quality Payment Program as part of its effort to reduce provider burden. “Clinicians are drowning in paperwork and reporting requirements caused by cumbersome government rules and regulations,” said CMS Administrator Seema Verma in a press […]
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CMS Proposes Updates for OPPS, Pitches Price Transparency Rules

CMS Proposes Updates for OPPS, Pitches Price Transparency Rules

The agency dropped proposals for three key payment programs aimed at cutting administrative burden and boosting price transparency. CMS has released three new proposed payment programs that aim to reduce administrative burden, put patients over paperwork, and increase price transparency for patients, the agency said in a statement emailed to journalists. Specifically, CMS has proposed […]
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