CMS

CMS proposes payment increases for IPPS hospitals and LTCHs

April 11, 2024 - CMS has proposed a 2.6 percent payment rate increase for acute care hospitals paid under the inpatient prospective payment system (IPPS) in FY 2025. The payment update reflects a hospital market basket percentage increase of 3.0 percent and a 0.4 percentage point reduction for productivity. IPPS hospitals that successfully participate in the...

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Strategies for integrating specialty care into value-based care models

by Victoria Bailey

Value-based care models must address both primary and specialty care to improve patient outcomes and reduce spending. A CMS Innovation Center strategy details ongoing efforts to integrate specialty...

CMS releases tool to help hospitals with price transparency

by Jacqueline LaPointe

CMS recently released a web-based validation tool that assists hospitals with price transparency compliance. The updated V2.0 Online Validator Tool helps hospitals develop machine-readable files to...

CMS proposes FY 2025 Medicare payment rates for hospice, IPFs

by Jacqueline LaPointe

CMS proposes a 2.6% hospice payment update for the fiscal year (FY) 2025, which would add about $705 million to payments versus this year. The newly proposed rule (CM-1810-P) states the update comes...

Skilled nursing facility proposed rule updates payment rates, VBP program

by Victoria Bailey

CMS has released the Skilled Nursing Facility Prospective Payment System (SNF PPS), proposing a payment rate increase, revisions to nursing home enforcement authority, and updates to the quality...

CMS proposes 2.8% payment rate boost for inpatient rehabilitation facilities

by Victoria Bailey

CMS has proposed to increase payment rates for inpatient rehabilitation facilities (IRFs) by 2.8 percent in 2025. The payment update in the IRF Prospective Payment System (PPS) reflects a market...

CMS announces new ACO model focused on primary care

by Jacqueline LaPointe

CMS will test a new accountable care organization (ACO) model that focuses on primary care providers starting next year. A recent announcement states that CMS will launch a five-year voluntary ACO...

Making ACOs More Accessible for Long-Term and Post-Acute Care Providers

by Victoria Bailey

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of ACOs (NAACOS) have released recommendations on how to increase accountable care...

Overcoming the Barriers to Value-Based Payment in Primary Care

by Victoria Bailey

Primary care is arguably the most critical component of our healthcare system. Primary care and preventive medicine can help avert and manage chronic diseases and prevent long-term complications. However, efforts to improve primary care...

After Slowdown, ACO Participation in Shared Savings Program Grows

by Jacqueline LaPointe

More accountable care organizations (ACOs) are participating in Medicare programs this year, including a new, permanent payment option in the Shared Savings Program. CMS recently announced ACO...

Provider Groups Say Final Rule Will Relieve Prior Authorization Burdens

by Victoria Bailey

Provider groups are commending CMS for finalizing patient data-sharing policies and prior authorization requirements. The CMS Interoperability and Prior Authorization Final Rule requires Medicare...

New Medicaid Payment Model Targets Behavioral Health Integration

by Jacqueline LaPointe

CMS has announced a new Medicaid payment model that will incent care coordination across physical, behavioral, and social providers to improve the quality of care Medicare and Medicaid beneficiaries...

Primary Care Model Did Not Reduce Healthcare Spending or Improve Care

by Victoria Bailey

The CMS Comprehensive Primary Care Plus (CPC+) model was not associated with reduced healthcare expenditures or care quality improvements, a study published in JAMA found. CMS launched the five-year...

CMS Model Aims to Improve Maternal Health Outcomes, Access to Care

by Victoria Bailey

CMS has launched a new care delivery model to address maternal health outcomes and increase pregnancy and postpartum care access. The Transforming Maternal Health (TMaH) model will run for ten years...

How Nursing Homes Can Prepare for Staffing Standards, Gaps

by Victoria Bailey

After experiencing the brunt of the COVID-19 pandemic, long-term care facilities have prioritized strategies to improve staffing levels and care quality. The federal government has taken action, too, proposing minimum staffing standards...

CMS Will Issue OPPS Providers Lump-Sum Payments to Remedy 340B Losses

by Victoria Bailey

Hospital Outpatient Prospective Payment System (OPPS) providers participating in the 340B drug pricing program will receive a one-time lump-sum payment to offset losses between calendar years (CYs)...

CMS Finalizes 1.25% Cut To Medicare Physician Fee Schedule

by Jacqueline LaPointe

CMS has released the Medicare Physician Fee Schedule (PFS) final rule for calendar year (CY) 2024, finalizing a 1.25 percent overall reduction for physician services next year. The federal agency...

CMS Finalizes a $140M Increase to Medicare Home Health Payment Rates

by Victoria Bailey

After initially proposing a decrease, CMS has finalized a 0.8 percent increase in Medicare payment rates for home health agencies in 2024, boosting reimbursement by $140 million compared to 2023. The...

CMS Boosts End-Stage Renal Disease Medicare Rates by 2.1%

by Jacqueline LaPointe

CMS recently released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule for 2024, which includes a 2.1 percent Medicare rate hike for renal dialysis services furnished to...

Only 19% of Nursing Homes Currently Meet Proposed Staffing Standards

by Victoria Bailey

Less than 20 percent of nursing homes currently meet the proposed staffing standards for long-term care facilities, a KFF brief revealed. In September, CMS released a proposed rule with three main...

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