The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
Last Friday, April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposal to rectify a few of the issues many Americans face with Medicare enrollment.
The CMS press release says the proposed rule will implement provisions from the Consolidated Appropriations Act of 2021 and President Joe Biden's executive...
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the Hospital Inpatient Prospective Payment (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule, which will update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for fiscal year 2023. The rule includes a 3.2% increase...
This week in Medicare Advantage (MA), the program is on track to account for 54% of Medicare spending by 2030 and the Centers for Medicare and Medicaid Services (CMS) finalized the plan rates for 2023. Also, Humana takes a look at social needs in Medicare Advantage before COVID and eHealth looks at the rise in premiums and deductibles...CMS Rules
On Monday, the Centers for Medicare and Medicaid Services (CMS) filed the Fiscal Year 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule. The reimbursements include a 3.9% increase to industry reimbursements, but in aggregate the impact of payment policies would result in a decrease of $320 million in...CMS Rules
On February 24, the Centers for Medicare and Medicare Services (CMS) gave a long-awaited announcement regarding the future of the Global and Professional Direct Contracting Model (GPDC). The existing model will phase out by December 31, 2022 and will be redesigned to create the Accountable Care Organization Realizing Equity, Access and...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will give physician groups participating in the Merit-based Incentive Payment System (MIPS) additional time to apply for a waiver that will allow their data to be re-weighted to account for the impacts of COVID-19 and the surge in cases related to the Omicron variant. CMS has assured...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
The Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that takes aim at prescription drug costs in Medicare Advantage (MA) and Medicare Part D plans. The agency said the rule would reduce out-of-pocket costs for beneficiaries and improve price transparency as well as "market competition in the Part D...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that included changes to the physician fee schedule (PFS) and changes to payments for Medicare Part B. The agency also announced an increase in Part B beneficiary premiums due in part to the authorization of the controversial Alzheimer's drug Aduhelm,...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) updated its guidance for nursing home visitations during the COVID-19 pandemic this week. Although the guidance relaxes previous regulations, the agency notes its concern for the vaccination rates of nursing home employees. Unfortunately, unlike most other areas of the medical...CMS Rules
On Tuesday, the Centers for Medicare and Medicaid Services issued a final rule for the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS). The PFS includes policy changes for Medicare payments and Medicare Part B, and is the major mechanism for rate setting for the Medicare program as a whole. The PFS must remain budget...CMS Rules
The Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH) received a new final rule from the Centers of Medicare and Medicaid Services (CMS) this week. The rule helps providers by dropping a requirement that would have forced hospitals to disclose their contract terms...CMS Rules
The Centers for Medicare & Medicaid Services (CMS) released its proposal for the 2022 Physician Fee Schedule and Quality Payment Program rules with a focus on addressing health disparities in vulnerable communities.
Significantly, the fee schedule proposes a 3.75% cut in reimbursements to physicians in order to maintain budget...CMS Rules
The Centers for Medicare & Medicaid Services proposed a new rule last week that would impose higher penalties for large hospitals that fail to comply with price transparency rules.
From U.S. Department of Health and Human Services Secretary Xavier Becerra:
With today's proposed rule, we are simply showing hospitals through...CMS Rules
The Centers for Medicare & Medicaid Services (CMS) have recently taken steps to correct Stark Law, and released an advisory this week that applies to physician groups providing services through wholly owned subsidiary practices that are separately enrolled in Medicare.
The federal physician self-referral law, popularly known...CMS Rules
The Centers for Medicare & Medicaid Services (CMS) included provisions to expand reimbursement for telehealth services for mental and behavioral health care in the proposed 2022 Physician Fee Schedule released Tuesday. The proposal includes paying providers for audio-only services.
Telehealth use was widely expanded by CMS...
Last Thursday, the U.S. Department of Health and Human Services (HHS) issued an interim final rule that aims to protect consumers from surprise and balance billing practices and restricting out-of-pocket costs. Surprise billing was a major campaign concern for both presidential candidates and the Biden Administration is acting on...
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Monday that will expand the home health value-based purchasing (HHVBP) model, which was originally developed by the Center for Medicare & Medicaid Innovation (CMMI) in 2016. The rule also includes updates to the Medicare Home Health Prospective Payment...