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CMS Rules

CMS Rules

Paying the Price for Hospital and Physician Practice Mergers

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...
CMS Rules

Trump Administration Backs Off on Price Transparency Proposal

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

CMS Finalizes 2020 Site Neutral & 340B Cuts Despite Federal Court Losses

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

New SNF Value-Based Payment System Brings Big Changes

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

ACA Exchange Plans Required to Exhibit Star Ratings in 2020

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

CMS Promulgates Rule to Increase Transparency and Allow Flexibility

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...
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