News & Analysis as of

Patient Prospective Payment System Centers for Medicare & Medicaid Services (CMS)

McDermott+

McDermottPlus Check-Up: August 4, 2023

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Congress is officially in recess for the month of August and will return after Labor Day. On the regulatory front, the Centers for Medicare & Medicaid Services (CMS) released the final fiscal year (FY) 2024 Inpatient...more

King & Spalding

CMS Issues Outpatient Prospective Payment System Proposed Rule for CY 2022

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On July 19, 2021, CMS published a proposed rule to update the payment policies, payment rates and other provisions for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory...more

Robinson+Cole Health Law Diagnosis

CMS Finalizes 2021 End-Stage Renal Disease Prospective Payment System Rule Expanding Payments for In-Home Dialysis Equipment and...

On November 2, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized its 2021 End-Stage Renal Disease Prospective Payment System Rule. Among other things, the final rule expands Medicare payments for in-home...more

King & Spalding

CMS Issues Medicare IPPS and LTCH Final Rule for FY 2021

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On September 2, 2020, CMS issued the fiscal year (FY) 2021 final rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Final Rule). This article...more

Robinson+Cole Health Law Diagnosis

CMS Proposes 2021 End Stage Renal Disease Prospective Payment System Rule

On July 6, 2020 the Centers for Medicare and Medicaid Services (CMS) proposed its calendar year 2021 End Stage Renal Disease (ESRD) Prospective Payment System (PPS) rule. ESRD PPS rules are promulgated on an annual basis...more

Foley & Lardner LLP

Medicare Remote Patient Monitoring: CMS Finalizes New Code and General Supervision

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CMS just released the 2020 final rule with changes to remote patient monitoring (RPM), officially titled “Chronic Care Remote Physiologic Monitoring,” reimbursed under the Medicare program, as part of the Physician Fee...more

Baker Donelson

OIG Finds Continued Procedural Errors in Hospital Outlier Payment Reconciliations

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The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently released a report concluding that there are vulnerabilities in the process of reconciling Medicare hospital outlier payments....more

King & Spalding

Bipartisan Congressional Opposition Mounts Against Proposed CY 2019 Home Health Groupings Model in Home Health PPS Proposed Rule

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On July 28, 2017, CMS published the calendar year (CY) 2018 Home Health Prospective Payment System (PPS) Proposed Rule (the Proposed Rule) in which it proposed a new CY 2019 Home Health Groupings Model (HHGM). The proposed...more

Baker Donelson

CMS Issues CY 2017 ESRD Final Rule

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On October 28, 2016, CMS issued the final rule updating the payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services beginning in CY 2017. The rule also...more

King & Spalding

Also In The News - Health Headlines - October 2016

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CMS Releases 2017 Final Rule For ESRD Prospective Payment System – On October 28, 2016, CMS released the final rule for the End-Stage Renal Disease (ERSD) Prospective Payment System (PPS) that updates and makes revisions to...more

Sheppard Mullin Richter & Hampton LLP

CMS Releases 2017 Medicare Hospital Payment Rates, Penalties for Poor Performers

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) modifying the Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

Sheppard Mullin Richter & Hampton LLP

CMS 2017 Proposal Reduces Home Health Reimbursements by $180 Million

On June 27, CMS issued a proposal for the 2017 Medicare home health prospective payment system (HH PPS). CMS is proposing a $180 million reduction in 2017. This equates to a 1% drop in reimbursements for home health...more

King & Spalding

CMS Issues Proposed Rule to Update Policies and Payment Rates for Renal Dialysis Services and Medical Equipment Bidding

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On June 24, 2016, CMS issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or...more

Baker Donelson

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

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On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

Baker Donelson

CMS Issues CY 2016 HHA PPS, Value-Based Purchasing and Quality Reporting Final Rule

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On November 5th, CMS published the Final PPS Rule for Home Health Agencies (HHAs) for CY 2016. The rule implements annual changes to the PPS rates for HHAs and represents the third year in a four-year rebasing of the rates....more

McGuireWoods LLP

CMS Adopts ESRD PPS and QIP Final Rule for Dialysis Services

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On November 6, 2015, the Centers for Medicare and Medicaid Services (CMS) published the final rule regarding the end-stage renal disease (ESRD) prospective payment system (PPS) for renal dialysis services furnished to...more

Arnall Golden Gregory LLP

CMS Implements Changes to Prospective Payment System for Long-Term Care Hospitals

The Centers for Medicare & Medicaid Services (CMS) has implemented a revised payment system for Long-Term Care Hospitals (LTCHs). The changes, which became effective on October 1, define two separate payment categories for...more

McGuireWoods LLP

Washington Healthcare Update

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This Week: Senate Judiciary Committee Hearing Focuses on Health Insurers Merger... Arkansas to Delay Setting Up Its Own State Exchange...The Centers for Medicare and Medicaid Services (CMS) Announces Medicare Advantage...more

Baker Donelson

Value-Based Payments Transition to Post-Acute Care: The FY 2016 Skilled Nursing PPS Rule

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CMS published the final FY2016 Skilled Nursing Facility Prospective Payment System rule on August 4, 2015. In addition to updating the overall payment rate, the new rule implements key features of the Protecting Access to...more

Baker Donelson

Home Health, CY 2016 Proposed Rule: Emphasis on Value-Based Purchasing

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On July 10, 2015, CMS published the calendar year (CY) 2016 home health prospective payment system (PPS) proposed rule [PDF]. While the proposed rule updates and revises certain payment rates and quality measures, it also...more

McGuireWoods LLP

Washington Healthcare Update

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This Week: FDA Begins Device User Fee Talks with Patients and Consumers Sept. 15... CMS Extends Partial Enforcement Delay of Two-Midnight Policy Through 2015... Alaska Legislature Sues Governor Over Medicaid Expansion....more

Baker Donelson

CMS Issues FY 2016 Final Inpatient and Long-Term Care Hospital Rule

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On July 21, 2015, CMS issued a final rule updating the fiscal year (FY) 2016 Medicare payment polices and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment...more

McDermott Will & Emery

Shifting Hospice Reimbursement – Moving in the Direction of Aligning Payment with Resource Concentration

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The United States Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published its update to the home health prospective payment system (HHPPS) for fiscal year (FY) 2016 in the August...more

Baker Donelson

CMS Issues CY 2016 Proposed Rule for OPPS, ASC Payment Systems and Quality Reporting

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On July 8, 2015, CMS published in the Federal Register [PDF] its proposed changes and updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy...more

McGuireWoods LLP

Washington Healthcare Update

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This Week: Senate Reauthorizes Older Americans Act; Bill Heads to the House... White House Holds 2015 Conference on Aging and Launches Several New Administration Healthy Aging Initiatives Enveloping Alzheimer’s, Dementia,...more

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