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Medicare Finalizes Appeals Process for Reclassified Outpatient Observation Patients

On October 11, 2024, CMS issued a final rule establishing a new appeals process for Medicare beneficiaries who were initially admitted to a hospital as an inpatient but are later reclassified as an outpatient receiving...more

CMS Issues IPPS and LTCH Final Rule for FY 2025

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

CMS Issues Retroactive Final Rule Keeping Part C Days in the Medicare Fraction of the DSH Calculation

On June 7, 2023, CMS issued a final rule retroactively re-adopting its policy requiring patient days attributable to Medicare Part C beneficiaries (Part C days) to be counted in the Medicare fraction of the disproportionate...more

CMS Begins Reprocessing Payment to 340B Hospitals Following Federal Court Ruling

On October 13, 2022, CMS announced that it will revert to paying the statutory rate of average sales price (ASP) plus 6% for 340B-acquired drugs on a prospective basis. This announcement comes on the heels of a September 28,...more

CMS Issues IPPS and LTCH Final Rule for FY 2023

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

D.C. Circuit Issues Favorable Decision in Medicare Clinical Laboratory Case

On July 15, 2022, the D.C. Circuit issued a decision in favor of the American Clinical Laboratory Association (ACLA) in American Clinical Laboratory Association v. Becerra. The decision is the latest chapter in long-pending...more

CMS Extends CJR Model for Another Three Performance Years with Changes

On April 29, 2021, CMS issued a final rule extending the Comprehensive Care for Joint Replacement (CJR) bundled-payment model for an additional three performance years (the Final Rule). Originally slated to end September 30,...more

Court of Appeals Reverses Hospitals’ Victory in 340B Drug Reimbursement Case

On July 31, 2020, the U.S. Court of Appeals for the District of Columbia Circuit reversed a district court decision that had found unlawful Medicare’s nearly 30 percent rate cut for separately payable outpatient drugs...more

CMS Issues Final Rule for MA and Part D Plans Just Ahead of Plan Bidding Deadline

On May 22, 2020, CMS issued a final rule for CY 2021 implementing a portion of the Medicare Advantage (MA) and Prescription Drug Benefit (Part D) proposed rule it issued on February 18, 2020 (the Final Rule). The primary...more

CMS Issues Final Rule Aimed to Reduce Burden on Providers and Suppliers Through Regulatory Reforms

On September 26, 2019, CMS issued a Final Rule that CMS intends will reform certain Medicare regulations related to standards and certifications that CMS identified as “unnecessary, obsolete, or excessively burdensome.” CMS...more

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