On August 1, 2024, CMS filed a display copy of its final rule for Fiscal Year (FY) 2025 pertaining to the Inpatient Prospective Payment Systems (IPPS) for general acute care hospitals and long-term care hospitals (LTCHs) (the...more
On April 4, 2024, CMS published a final rule implementing certain policy changes to the Medicare Advantage (MA) Program (Medicare Part C) and the Medicare Prescription Drug Benefit Program (Medicare Part D). According to the...more
4/16/2024
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Beneficiaries ,
Brokers ,
Centers for Medicare & Medicaid Services (CMS) ,
Chronic Care Managment (CCM) ,
Compensation ,
Final Rules ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Medicare Part C ,
Medicare Part D ,
Mental Health ,
Policies and Procedures ,
Scope of Coverage ,
Substance Abuse ,
Third-Party
On February 21, 2024, CMS published a transmittal on its website with instructions for Medicare Administrative Contractors (MACs) to implement CMS’s final rule, issued June 9, 2023, concerning the treatment of the Part C days...more
On February 9, 2024, Judge Trevor McFadden of the United States District Court for the District of Columbia issued a decision holding that CMS miscalculated the Medicare reimbursement owed to five plaintiff hospitals for the...more
On January 25, 2024, CMS released a Request for Information (RFI) seeking public input on how it can enhance and increase transparency of Medicare Advantage (MA) data. CMS says that the RFI “builds on our existing MA data...more
On July 13, 2023, 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
On April 10, 2023, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for Fiscal Year (FY) 2024 (the Proposed Rule). In the...more
On March 16, 2023, CMS issued Change Request 12669, which contains instructions for Medicare Administrative Contractors (MACs) to begin the process of retroactively reimbursing DSH hospitals for inpatient days attributable to...more
On February 24, 2023, CMS issued a proposed rule that would modify the Medicare Disproportionate Share Hospital (DSH) payment regulation to limit the universe of Section 1115 demonstration beneficiaries who can be “regarded...more
On December 29, 2022, CMS posted on its website Transmittal 18, which implements sweeping changes to the Medicare cost report for hospitals and its accompanying instructions. The revisions affect nearly every facet of...more
On November 29, 2022, the Health Resources and Services Administration (HRSA) issued a proposed rule (Proposed Rule) to revise the alternative dispute resolution (ADR) procedures for disputes arising under the 340B drug...more
On November 3, 2022, CMS posted a notice on its website announcing the Phase 2 deadline for teaching hospitals to request review of the cost report data that the agency is using to determine whether hospitals are eligible...more
Last week, CMS released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) final rule (the Final Rule). Under the Final Rule, CMS finalized a number of updates, revisions, and changes to Medicare payment policies for...more
On August 1, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2023 (the Final Rule). In the Final Rule, CMS...more
8/10/2022
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Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Final Rules ,
Full-Time Employees ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Payment Rates ,
Rulemaking Process ,
Value-Based Purchasing ,
Wage Index
On July 1, 2022, CMS issued a proposed rule in which the agency proposes to update and potentially liberalize the distance rules applicable to Critical Access Hospitals (CAHs) as well as procedures for monitoring the...more
On April 18, 2022, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2023 (the Proposed Rule). In the Proposed Rule,...more
4/27/2022
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Medicare Advantage ,
Payment Rates ,
Proposed Rules ,
Rulemaking Process ,
Wage Index
On December 23, 2021, CMS announced that it was rescinding its prior approval of the Georgia Pathways to Coverage demonstration project, which would have required Georgia residents to work as a condition of Medicaid...more
On December 17, 2021, CMS issued a final rule implementing three changes to Medicare’s payment rules for graduate medical education that Congress enacted last year in the Consolidated Appropriations Act, 2021 (CAA). The final...more
On November 2, 2021, CMS published the final rule to update the payment policies and rates for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment...more
On August 2, 2021, CMS published the Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule for federal fiscal year (FY) 2022. The final...more
8/10/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Workers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Medicare ,
Medicare Advantage ,
Prospective Payment System (PPS) ,
Reporting Requirements ,
Vaccinations ,
Wage Index
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
7/27/2021
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Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Consumer Price Index ,
Food and Drug Administration (FDA) ,
Medicare ,
Patient Prospective Payment System ,
Price Transparency ,
Proposed Rules ,
Public Health Emergency ,
Reporting Requirements ,
Rural Health Care Providers ,
Social Security Act
On June 16, 2021, the Provider Reimbursement Review Board (PRRB) issued proposed changes to its rules and an order requiring all submissions for new and/or pending appeals to be filed electronically using the Office of...more
On Monday, May 17, 2021, Judge Timothy Kelly of the United States District Court for the District of Columbia issued a decision setting aside a regulatory formula CMS has adopted to compute Medicare DGME payments to...more
On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more
5/10/2021
/ ACOs ,
American Rescue Plan Act of 2021 ,
Bad Debt ,
CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Graduate Medical Education ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Interim Final Rules (IFR) ,
Long-Term Care ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Shared Savings Program ,
Proposed Rules ,
Public Health Emergency ,
Rural Health Care Providers
On March 31, 2021, Judge Carl Nichols of the United Stated District Court for the District of Columbia issued a decision upholding CMS’s denial of reimbursement to a California Critical Access Hospital (CAH) for compensation...more