CMS wants to increase the amount of encounter data the agency uses to calculate Medicare Advantage (MA) risk scores from 50% to 75%; final 2021 MA payment rates are expected on or before April 6.
Even as the industry continues to express...CMS Rules
This year, the Centers for Medicare and Medicaid Services (CMS) will implement a lower physician supervision requirement for hospital outpatient therapeutic services. CMS has required direct supervision of services such as, chemotherapy and radiation therapy for the past decade.
The change was finalized in November 2019, making...CMS Rules
Hospice advocates are calling for a delay to the Centers for Medicare and Medicaid Services' (CMS) Medicare Advantage (MA) carve-in demonstration set to begin in Jan. 2021.
Earlier this year, the agency announced it would start testing hospice care coverage through MA plans in 2021 with the intention of increasing care...CMS Rules
National enrollment for 2020 health plans on HealthCare.gov totaled 8.3 million for the open enrollment period ending on Dec. 15. But this year because some consumers attempting to enroll during the final hours experienced issues, the deadline for sign up was extended until 3 a.m. EST Dec. 18.
This year, shoppers seeking health...CMS Rules
Last Monday, a federal judge denied a request from hospitals to halt the site-neutral provisions in the Outpatient Prospective Payment System (OPPS) for 2020, a rule finalized in September by the Centers for Medicare and Medicaid Services (CMS). Following the original announcement, United States District Court Judge Rosemary Collyer in...
A report from the Department of Health and Human Services (HHS) inspector general's office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector...
The Centers for Medicare and Medicaid Services (CMS) recently issued a request for applications (RFA) for two of the three voluntary payment model options, specifying how accountable care organizations can apply to participate in the professional and global options of Direct Contracting (DC).
Defined within DC are three different...CMS Rules
Medicare open enrollment for 2020 coverage ended Saturday, Dec. 7, and while the Centers for Medicare and Medicaid Services (CMS) indicated a special enrollment period (SEP) for seniors who enrolled in a plan based on erroneous information, senators are calling for CMS to specify information regarding the SEP and make it available for...CMS Rules
For the first time in the last decade, the Centers for Medicare and Medicaid Services (CMS) updated the popular health plan shopping tool Medicare Plan Finder, but the recent redesign initiative has raised concerns for consumer advocacy groups that say the tool offers inaccurate information.
The federal government spent $11 million...CMS Rules
A new analysis of the decline in hospital readmission rates suggests ties to a drop in hospital admissions all together, rather than a Centers for Medicare and Medicaid Services (CMS) value-based purchasing program as previously credited.
The Medicare Hospital Readmissions Reduction Program (HRRP) is a value-based purchasing...CMS Rules
The final rule provides details on the requirements for making public discounted cash prices, payer-specific negotiated charges and de-identified minimum and maximum negotiated charges for at least 300 ‘shoppable’ services, publicly available in a consumer-friendly format effective January 1, 2021.
The Health & Human Services...CMS Rules
The American Association of Nurse Anesthetists (AANA) is celebrating newly established rules, expanding the recognition and responsibilities of Certified Registered Nurse Anesthetists (CRNA).
On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the new Medicare Physician Fee Schedule (PFS) to take effect...CMS Rules
Medicare beneficiaries will see a 7 percent increase in monthly premiums and annual deductibles for 2020 Part B coverage, which takes care of physician services, outpatient hospital services, explicit home health services and durable medical equipment.
The Centers for Medicare and Medicaid Services (CMS) announces the rates for...CMS Rules
Hospitals are increasingly gobbling up physician practices and Medicare beneficiaries are paying the price.
The Centers for Medicare & Medicaid Services (CMS) offers providers better reimbursement rates for services performed at physician practices. To take advantage of this, hospitals are buying such practices and...CMS Rules
After the publication of the Outpatient Prospective Payment System (OPPS) on Friday, the Trump Administration is holding off on a controversial transparency rule that would require hospitals to publicly post all privately negotiated payer rates. The Centers for Medicare and Medicaid Services (CMS) has promised to issue a "forthcoming...CMS Rules
The final rule with comment period updates and revises policies under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.
Hospital advocates aren't taking the news lightly since Medicare Part B reimbursement cuts to hospitals for drugs purchased through the 340B...CMS Rules
Starting Oct. 1 therapy payments to nursing facilities will shift to a value-based model, emphasizing patient needs over the amount of services provided. The Patient Driven Payment Model (PDPM), a more individualized approach, aims to reduce inflated billing by basing payments on patient's medical characteristics.
The new approach...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced Aug. 15 that all plans on HealthCare.gov will be required to display quality star ratings during the 2020 open enrollment.
CMS said in a news release, the move builds on efforts by the Trump Administration to increase transparency and encourage informed coverage...CMS Rules
The Centers for Medicare and Medicaid Services has finalized a rule intended to make prices more transparent with Medicare Part D drug plans and allow plan sponsors to use cost-cutting tools such as step therapy under certain circumstances.
"CMS is delivering on price transparency, because patients have a right to know the cost of...