Last week, the Centers for Medicare and Medicaid Services made hospitals very unhappy with the 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS) final rule, which includes major plans for site-neutral payments and price transparency policies.
The rule gives both outpatient departments and...National News
After discovering widespread fraud amounting to billions of inaccurate billing for catheters, the Centers for Medicare and Medicaid Services (CMS) proposed a rule absolving participating accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP).
In 2023, CMS observed "significant, anomalous, and highly...National News
The latest report highlights ongoing financial challenges faced by American hospitals and health systems that are impacting their capacity to deliver round-the-clock care to patients and communities.
According to the American Hospital Association report, in 2023, hospitals and health systems again sustained substantial expenses due to...
The Lown Institute, a nonpartisan think tank that studies hospital spending and community health, released a new analysis of nonprofit hospital spending based on 2021 Internal Revenue Service data and found that the majority of hospitals receive more in tax break benefits than they spend in community support.
Of the nearly 2,500...
The Medicare Payment Advisory Committee (MedPAC) met last Thursday to discuss recommendations for Medicare-related payment rates as Congress and the Centers for Medicare and Medicaid Services (CMS) gear up to address industry reimbursement in 2025.
The committee recommended raises for the hospitals and physicians but wants lower base...National News
The Affordable Care Act of 2010 requires private insurers to cover a range of preventive services outlined by the U.S. Department of Health and Human Services with no out of pocket cost, but many insurers are failing to let consumers know of these prepaid benefits. This revelation comes as the "free" preventive services are caught in...
The Medicare Payment Advisory Commission (MedPAC) published its annual June Report to Congress, which includes suggestions to unify payment methodologies for post-acute care, address issues within Medicare Advantage, and lower telehealth payments.
The MedPAC recommendations for streamlining payment methodologies for skilled nursing...
On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed the FY 2024 Skilled Nursing Facility (SNF) Payment Prospective Systems (PPS) rates. It includes an increase of 3.7%, or $1.2 billion in Medicare Part A payments to SNFs.
The rate increase reflects a 6.1% market basket update to the payment rates comprised of a...
The American Hospital Association's study showed Medicare patients who receive outpatient hospital care are more likely to come from an underserved community than those treated in independent physician offices (IPO) or ambulatory surgical centers (ASC).
The study, "Comparison of Medicare Beneficiary Characteristics Between Hospital...Arizona News
Last week, the Centers for Medicare and Medicaid Services (CMS) announced plans to extend the Medicare Advantage (MA) Value-Based Insurance Design Model for five more years, through 2030.
According to the American Hospital Association, 52 Medicare Advantage organizations with a collective 9.3 million enrollees are participating int he...
The Medicare Payment Advisory Committee (MedPAC) submitted its
March 2023 Report to Congress which included its 2024 payment recommendations for Medicare fee-for-service (FFS), Medicare Advantage (MA) and the Medicare prescription drug program (Part D). This year's report is likely to please no one as the committee took aim at claims of...
Last week, the Medicare Payment Advisory Commission (MedPAC) made its recommendations to Congress for Medicare payment rates for hospitals and physicians.
Commissioners made it known that the recommendations were a reflection of the current environment and issues related to the COVID-19 pandemic, but didn't recommend to raise rates...National News
On Tuesday morning, Congressional lawmakers unveiled a titanic omnibus spending bill that includes a 2% cut to Medicare reimbursement rates for doctors, an extension of the telehealth and hospital-at-home waivers, and several other measures that would unwind policies enacted during the COVID-19 public health emergency (PHE) prior to the...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...National News
Last week, Judge Rudolph Contreras, a federal judge with the U.S. District Court for the District of Columbia ruled that the U.S. Department of Health and Human Services (HHS) must restore full 340B payments to participating hospitals for the rest of the calendar year.
This is the second successive blow to HHS regarding 340B payments,...National News
The American Hospital Association (AHA) and the American Medical Association (AMA) will end a legal challenge to federal rules on surprise billing arbitration but intend to file another suit in the future.
The suit was filed against the federal government last December, with the aggrieved parties arguing that the surprise billing...Arizona News
Protecting health care workers from harassment was the headline concern at a National Academies of Sciences, Engineering and Medicine (NASEM) last Thursday. The event, "The Targeting of Scientists and Public Health Professionals," was the first in a planned series that will address increases in harassment and violence toward public...CMS Rules
In 2020, the Centers for Medicare and Medicaid Services (CMS) reevaluated and revised the Hospital Overall Star Ratings methodology to streamline the ratings process and improve equitable ratings throughout a highly-varied industry. The American Hospital Association (AHA) reviewed the changes and found that they provide some stability...
On Wednesday, the U.S. Supreme Court unanimously sided with the American Hospital Association (AHA) against the U.S. Department of Health and Human Services (HHS) in a case that challenged a Centers for Medicare and Medicaid Services (CMS) rule that would have cut outpatient drug payments for hospitals that treat Medicaid enrollees and...
According to USA Today, The United States of America represented 16% of the world deaths, while only representing 4% of the world population. Of countries with at least 5 million cases, the US is third in deaths per 1000 at 303. "First" on the list is Brazil with 313 and next is Poland with 307. Canada had 105 deaths per thousand and...
