Tag: CMS

cms-asks-medicare-advantage-plans-to-relax-prior-authorizations

CMS Asks Medicare Advantage Plans to Relax Prior Authorizations

  The agency emphasized relaxing prior authorizations that could impact transferrals between general acute-care hospitals and longer-term care facilities. CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant. “The ability of hospitals to transfer patients to appropriate levels of care without unnecessary delays […]
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Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

A leaked CMS report targeting HCA Healthcare-owned Good Samaritan Hospital in California warns the hospital to fix Medicare noncompliance issues or risk termination. A leaked CMS report put HCA Healthcare-owned Good Samaritan Hospital in California at risk of program termination by October if they fail to fix Medicare noncompliance issues that resulted in patient harm. […]
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many-final-ipps-rules-are-released

Many Final IPPS Rules Are Released

While much attention has been focused on the release of the IPPS Final Rule, other final rules might have gone unnoticed. The Centers for Medicare & Medicaid Services (CMS) were very busy the first week of August, with the release of final rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs), and inpatient […]
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cms-prior-authorization-operational-and-financial-impact

CMS Prior Authorization—operational And Financial Impact

CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
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Hospital Price Transparency Strategies for Compliance, Patients

Hospital price transparency is now a requirement from CMS, but providers should be going beyond the rule to ensure transparency meets patient demands, too. Hospital price transparency goes beyond just compliance with federal regulations. Patients are also demanding more transparent pricing information from their providers in order to make more informed decisions about their healthcare. […]
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differentiating-hcpcs-levels-i-and-ii-code-sets

Differentiating HCPCS Levels I and II Code Sets

Deciding which code to use starts with determining each payer’s policy. The Healthcare Common Procedure Coding System (HCPCS) has two principal subsystems, referred to as Level I and Level II. Knowing when to use HCPCS Level I codes versus HCPCS Level II codes can be confusing, mainly because many services are described by both code […]
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key-quality-payment-program-changes-in-2022-pfs-proposed-rule

Key Quality Payment Program Changes in 2022 PFS Proposed Rule

CMS introduced the first seven MIPS value pathways and other updates to the Quality Payment Program as part of the Medicare Physician Fee Schedule proposed rule. If finalized, the Quality Payment Program (QPP) will undergo significant policy changes under the Medicare Physician Fee Schedule (PFS) proposed rule. Most notably, the rule introduced the first seven […]
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cms-forecasts-increase-in-dialysis-payment

CMS Forecasts Increase in Dialysis Payment, Health Equity Gap Reduction

Proposed rule improves payment rates, incentives, and ESRD treatment choices. Disadvantaged Medicare patients suffer from end-stage renal disease (ESRD) at higher rates and are also more likely to be readmitted to hospitals, experience higher costs, and receive in-center hemodialysis when their kidneys are no longer able to function properly. Furthermore, non-white patients with ESRD are […]
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