ESRD PPS 2025 Update: In the July 5 Federal Register, the Centers for Medicare & Medicaid Services (CMS) will publish a proposed rule for the calendar year (CY) 2025 End-Stage Renal Disease Prospective Payment System (ESRD PPS). A number of changes to Medicare policy and payment rates for ESRD facilities are included in the rule. Changes […]
The Final Decrease Is Influenced By Add-On Codes and Regulatory Obligations On November 16th, the Centers for Medicare & Medicaid Services (CMS) released the finalized rule for the 2024 Medicare Physician Fee Schedule (MPFS) in the Federal Register. While the policies exhibit several positives, especially in primary care, telehealth, and behavioral healthcare, CMS remains dedicated […]
The Centers for Medicare & Medicaid Services (CMS) have released the Final Rule for Inpatient Rehabilitation Facilities (IRFs) on July 23. The new rule updates payment policies, IRF Quality Reporting Program (QRP) requirements for the 2024 fiscal year (FY), and modifies the conditions for Excluded Units. This allows hospitals to open a new IRF unit […]
On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule seeking public feedback on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues. These changes are set to take effect on or after January 1, 2024. The proposed rule for […]
The 2024 Medicare Physician Fee Schedule proposal includes a reduction of 3.4% to the conversion factor that determines Medicare payment rates. This reduction will widen the gap between practice expenses and reimbursement. If the proposal is approved, the new conversion rate will be $32.7476. Here are some other key highlights of the CMS proposal: The […]
CMS dramatically increases financial penalties for noncompliance with hospital price transparency rules. On Nov. 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, finalizing payment rates and policy changes affecting Medicare services furnished […]
Medicare Radiology Payment System approach to advanced imaging reimbursement has been “dysfunctional” for decades, but health policy experts have a few suggestions to fix it. Over the past 20 years, the federal payment program witnessed “substantial” increases in the performance of MRIs, CT scans and nuclear studies, mostly in doc offices. A shift later […]
Physicians are asking for adequate reimbursement for all COVID-19 vaccines and their administration, according to a new policy statement from the American College of Physicians (ACP). The statement released on Jan. 12 calls on health policymakers to require insurers to “provide adequate reimbursement for all vaccines, including COVID-19 vaccines, administered according to” scientific guidelines established by […]
The $1.4 trillion omnibus legislative package passed by Congress late Monday includes COVID-19 related relief for physicians, imposes new restrictions on surprise billing, and funds the government through fiscal 2021, which ends Sept. 30. The legislation mitigates budget neutrality cuts that would have slashed physician Medicare payment rates by 10.2% and extends the moratorium on the […]
A version of this article was first published December 14, 2020, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. CMS recently released two new HCPCS Level II codes for Regeneron’s antibody drugs casirivimab and imdevimab, effective for dates of service on or after November 21. The creation of the new codes comes […]