Tag: Medicare Reimbursement

Medicare-Overpayments-to-Hospitals

CMS System Edits Reduced Medicare Overpayments to Hospitals

Medicare overpayments totaled $39.3 million between September 2016 and December 2021, but most of those improper payments occurred before CMS corrected its system edits error in May 2019. CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the […]
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Medicare-Outpatient-Payment-Updates-for-CY-2023

Medicare Outpatient Payment Updates for CY 2023

The proposed outpatient payment updates for 2023, including the 2.7 percent reimbursement increase, do not reflect the inflationary environment in which hospitals are operating. When commenting on the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, the American Hospital Association (AHA) supported […]
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No-Surprises-Act-More-to-Come

More Versions to Come: No Surprises Act

Although the Biden Administration claims this is the final regulation, there is evidence more is yet to come. The Biden administration released the final No Surprises Act regulation recently but advised healthcare professionals that this final version is not the final one and promised more to come. The latest final rule was narrowly focused on […]
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Home Health Medicare Reimbursement

Recent Updates on Home Health Medicare Reimbursement

AHA said that the 2.7 percent Medicare reimbursement update for home health agencies does not accurately reflect the financial challenges that home health agencies have faced during the pandemic. The American Hospital Association (AHA) has urged CMS to reconsider the Medicare reimbursement update for home health agencies proposed in the Calendar Year 2023 Home Health […]
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Prior-authorizations-and-MedPAC-recommendations

Prior Authorizations and MedPAC Recommendations: MGMA’s view

Prior authorizations and Medicare reimbursements are some of the most consistently cited sources of issues at primary care practices. Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), joined us in April to discuss his organization’s lobbying efforts. The following interview has been edited for length and clarity. Medical […]
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Final-Rules-for-Hospice-Providers-IPFs-IRFs-for-FY23

FY23 Final Rules for Hospice Providers, IPFs, IRFs

The final rules for fiscal year 2023 include a 3.8 percent payment increase for hospice providers, 2.5 percent increase for inpatient psychiatric facilities, and 3.2 percent boost for inpatient rehabilitation facilities. CMS has released final rules solidifying Medicare reimbursement rates for hospice providers, inpatient psychiatric facilities (IPFs), and inpatient rehabilitation facilities (IRFs) for fiscal year […]
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Update on Medicare Reimbursement for ESRD facilitie image

Update on Medicare Reimbursement for ESRD facilities

The CY23 End-Stage Renal Disease (ESRD) Prospective Payment System Proposed Rule would increase Medicare reimbursement rates, among other policy changes. CMS recently proposed the Calendar Year 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule, which would boost Medicare reimbursement for ESRD facilities and refine a new mandatory value-based purchasing program. The proposed […]
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Permanent Medicare Payment Adjustment for Home Health

Permanent Payment Adjustment for Home Health

The federal agency released the Home Health Prospective Payment System Rate Update proposed rule for CY23, which aims to permanently adjust Medicare payment based on PDGM. CMS proposes updated Medicare payment for home health agencies CMS is looking to apply a permanent prospective payment adjustment to the home health 30-day period payment rate to account […]
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medicare-beneficiaries-saw-higher-prices-at-provider-based-facilities

Medicare, Beneficiaries Saw Higher Prices at Provider-Based Facilities

The Medicare program and Medicare beneficiaries could have saved a combined $1.6 billion if provider-based facilities charged the same payment rate as freestanding facilities, OIG found. Medicare and its beneficiaries paid significantly higher prices at provider-based facilities than they would have paid to freestanding facilities for the same services, according to a report from the […]
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