This week The Centers for Medicare & Medicaid Services announced that it is lifting a suspension on hospital survey activities that was implemented during this winter's surge in COVID-19 cases and hospitalizations. An immediate resumption of...
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will increase the amount federal authorities can recoup from Medicare Advantage organizations (MAOs) that were overpaid due to incorrect diagnostic coding.
The Medicare Risk Adjustment Data Validation (RADV) final rule means that CMS will also stop...
On Wednesday, the U.S. Department of Health and Human Services announced its timeline for the Medicare Drug Price Negotiation Program, a key point of legislation in the Inflation Reduction Act (IRA).
In a press call, Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure said that the department will...
Medicaid contracted managed-care organizations (MCOs) can spend up to 5 cents of every premium dollar on SDOH needs. The new guidance says Medicaid MCOs can also reduce health disparities and address unmet health-related social needs such as housing instability and nutrition insecurity by adopting in lieu of services and settings (ILOS)...
The Centers for Medicare and Medicaid Services (CMS) have heard beneficiary complaints about predatory marketing tactics by Medicare Advantage (MA) companies and is taking action.
In August, Senator Ron Wyden (D-Ore.), Chair of the Senate Finance Committee, began an investigation into deceptive marketing practices . Last week, the...
The Centers for Medicare and Medicaid Services (CMS) has released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) final rule that reduces payments by almost 4.5% YOY and includes substantive changes for ACOs in the Medicare Shared Savings Program, expands access to behavioral health services, and decreases the conversion factor...CMS Rules
On November 1, the Centers for Medicare and Medicaid Services (CMS) finalized the Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rules. In the rule, OPPS and ASC payment rates will increase by 3.8% and announced a new provider designation: the rural...CMS Rules
Although budget cuts are still coming, home health agencies will receive a 0.7% pay increase, equaling $125 million, rather than the proposed $810 million budget cut, under the finalized rule for the Home Health Prospective Payment System Rate Update.
According to the Centers for Medicare and Medicaid Services (CMS), this increase...
Last Friday, the Biden administration announced it will immediately increase enforcement for nursing home requirements and tighten quality requirements for poor-performing facilities.
The Centers for Medicare and Medicaid Services (CMS) said that it would provide resources for poorly-performing nursing homes but maintains the threat...
The Centers for Medicare and Medicaid Services (CMS) announced the extension of the BPCI program to December 2025 along with the agency’s plans to release a 2023 RFA for Medicare ACOs interested in applying for the model, which was expected to end next year.
In 2018, the Bundled Payments for Care Improvement Advanced (BPCI...CMS Rules
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would streamline the application and renewal process for enrollees in Medicaid and the Children's Health Insurance Program (CHIP).
The overhaul aims to "reduce red tape" and simplify the application and verification process for children,...
Well ahead of the expected publication, the Centers for Medicare and Medicaid Services (CMS) posted a draft of updated Minimum Data Set specifications (MDS 3.0) last Friday. The comprehensive item set version 1.18.11 is expected to radically transform the future of nursing home reimbursements by states.
CMS said that the final version...
On July 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that included new payment model for rural emergency hospitals (REH). The designation seeks to alleviate financial disturbance in the continuity of care provided in areas with limited medical resources by shifting from an inpatient bed model to...
The Centers for Medicare and Medicaid Services (CMS) are signaling that the end of the COVID-19 public health emergency (PHE) is near.
Last week, CMS published a blog post called "Creating a Roadmap for the End of the COVID-19 Public Health Emergency," to help providers prepare for the end of the waivers and flexibilities that arrived...
Last Friday, the U.S. Departments of Health and Human Services, Labor and Treasury issued a joint final rule that rectifies issues with the implementation of the No Surprises Act, a law that aims to curb surprise billing practices.
The rule defines the processes for payers and providers to settle payment for services provided that...
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to improve quality reporting for Medicaid and the Children's Health Insurance Program (CHIP).
According to the CMS press release, the rule would include mandatory annual state reporting of three new quality measures, called "Core Sets,"...CMS Rules
The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act's enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for...CMS Rules
In a surprising turn of events, the Centers for Medicare and Medicaid Services issued the FY 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule which contains a 2.7% increase in Medicare rates to nursing homes. When the proposed payment rule was published in April, the agency had proposed cutting Medicare Part...
Last week, the Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI), seeking comment on ways to improve Medicare Advantage and make the program more equitable, affordable and sustainable.
Medicare Advantage (MA) has been under great scrutiny lately, for policies on prior authorization, the adequacy...
The rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals (LTCH) and builds on key priorities to advance health equity, including better measurements for healthcare quality disparities and improving the safety and quality of maternity care by establishing a...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) published a set of quality metrics for home and community-based services (HCBS) to assess patient health outcomes. According to CMS, the ratings will provide insight into HCBS programs and will enable states to determine the success of long-term services and support programs offered...
