News & Analysis as of

Final Rules Medicare Provider Payments

Cozen O'Connor

CMS Issues Final Rule Impacting Prior Authorization Process

Cozen O'Connor on

Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more

King & Spalding

CMS Issues FY 2024 Final Rule Updating Medicare Payment and Policies for Inpatient Rehabilitation Facilities

King & Spalding on

On July 27, 2023, CMS issued a final rule updating Medicare payments and policies under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program for FY 2024 (Final IRF...more

Nelson Mullins Riley & Scarborough LLP

HHS Finalizes Payment Rates and Policies for the 2024 Medicare Advantage Program

On March 31, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the finalized capitation rates and payment policies for the 2024 Medicare...more

McDermott Will & Emery

Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and...

McDermott Will & Emery on

Rural emergency hospitals (REHs) are a new provider type that will allow Medicare to pay for emergency department and other outpatient hospital services in rural areas beginning on January 1, 2023, without requiring the...more

King & Spalding

CMS Publishes Final Rule for CY 2020 Hospital Outpatient Prospective Payment System

King & Spalding on

n November 1, 2019, CMS posted the final rule establishing the payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System for calendar year (CY) 2020...more

Bricker Graydon LLP

Federal court invalidates CMS site-neutral payment cuts for hospital off-campus provider-based locations

Bricker Graydon LLP on

On September 17, 2019, the United States District Court for the District of Columbia ruled that the Center for Medicare and Medicaid Services (CMS) exceeded its authority and failed to follow the statutory process for setting...more

Baker Donelson

New Horizons Calling for Action Under Home Health Agency Final Rule

Baker Donelson on

On November 13, 2018, CMS/HHS published in the Federal Register the Home Health Final Rule. 83 FR 56406 (Nov. 13, 2018). We provided an overview of the proposed rule in Payment Matters on September 14, 2018. Home health...more

Baker Donelson

CMS Increases Hospice Payments, Updates Quality Reporting Requirements for 2019

Baker Donelson on

CMS updated payment rates, implemented statutory changes, and continued to provide guidance on quality reporting measures and requirements in the FY 2019 Hospice Wage Index and Payment Rate Update Final Rule published on...more

Seyfarth Shaw LLP

CMS Publishes Final Rule to Cancel Medicare Episode Payment and Cardiac Rehab Incentive Payment Models, and to Cut Back Joint...

Seyfarth Shaw LLP on

This is the first in a series of alerts from Seyfarth’s Health Law practice highlighting significant changes in health care regulations and policy as providers and other industry participants enter 2018. ...more

Baker Donelson

What's Next Now that Mandatory EPM and Cardiac Rehabilitation Payment Models Have Been Terminated?

Baker Donelson on

CMS released its Final Rule canceling the Episode Payment Model (EPM) and Cardiac Rehabilitation Incentive Payment Model (CR Incentive Payment Model). This was an expected result following August's proposed rule to cancel...more

Bass, Berry & Sims PLC

Final Home Health Rule Drops Controversial Proposed Payment Model

Bass, Berry & Sims PLC on

Last week, home health agencies welcomed the Centers for Medicare & Medicaid Services' (CMS) decision to drop a controversial proposed payment model and leave largely unchanged the current payment system. Responding to...more

Polsinelli

Medicare Mandatory Bundled Payments Rule: Minor Aspects Delayed, Others On-Schedule for July Implementation

Polsinelli on

In a move the Centers for Medicare & Medicaid Services cites as a reaction to President Donald Trump's regulatory freeze, CMS announced that implementation of certain minor aspects of the final rule expanding Medicare...more

Seyfarth Shaw LLP

The Brave New World of Physician Medicare Payment: MACRA Makes Sweeping Changes

Seyfarth Shaw LLP on

On November 14, 2016, CMS published its final rule implementing the physician payment provisions of the Medicare Access and CHIP Reauthorization Act (“MACRA”). The rule became effective January 1, 2017. Data collection from...more

Baker Donelson

Final Rule Implements Quality Payment Program under MACRA

Baker Donelson on

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

Baker Donelson

CMS Final Rule and 21st Century Cures Act Include Good and Bad News for Provider-Based Sites

Baker Donelson on

CMS recently published its final outpatient prospective payment system (OPPS) rule, which includes its new policies governing payment related to services furnished at off-campus provider-based departments (OPBDs). 81 Fed....more

Baker Donelson

The MOON Notification is Coming: CMS Publishes Final Changes

Baker Donelson on

CMS is moving forward with implementing the Medicare Outpatient Observation Notice (MOON) as announced in its FY 2017 IPPS Final Rule [PDF] on August 2, 2016, and published in the Federal Register on August 22, 2016 (Final...more

King & Spalding

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

King & Spalding on

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

King & Spalding

Payments to SNFs, Hospices and IRFs to Increase Under CMS Final Rules

King & Spalding on

On July 29, 2016, CMS released three separate final rules updating the fiscal year 2017 payment rates for skilled nursing facilities (SNFs), hospices and inpatient rehabilitation facilities (IRFs). Payments will increase...more

Bradley Arant Boult Cummings LLP

CMS Releases Final Rule to Implement Major Changes in Medicare Clinical Laboratory Payment Policy

On June 23, 2016, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule making major changes in the way Medicare will pay for clinical diagnostic laboratory tests (CDLTs). The changes were...more

King & Spalding

CMS Overhauls Clinical Laboratory Fee Schedule with Long-anticipated Final Rule

King & Spalding on

On June 17, 2016, CMS released a long-anticipated final rule revising the Medicare payment system for clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) (the Final Rule). In 2018,...more

Mintz - Health Care Viewpoints

At Long Last, CMS Issues Final Rule for Lab Fee Schedule Changes

Last Friday afternoon CMS released its eagerly anticipated final rule (the Final Rule) implementing the Protecting Access to Medicare Act of 2014 (PAMA), which, together with the Final Rule, will make sweeping changes to the...more

McDermott Will & Emery

CMS Finalizes Prior Authorization Program for Certain DMEPOS Items

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS)...more

King & Spalding

D.C. District Court Formalizes Remand of Allina Case Regarding the Appropriate Treatment of Medicare Part C Patient Days for...

King & Spalding on

On May 18, 2015, the United States District Court for the District of Columbia ordered HHS to adjudicate the appropriate treatment of Medicare Part C patient days in determining disproportionate share hospital (DSH) payments....more

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