CMS

Medicare Shared Savings Program ACOs Saved $1.8B in 2022, CMS Reports

by Victoria Bailey

The Medicare Shared Savings Program (MSSP) saved Medicare $1.8 billion in 2022, with 63 percent of accountable care organizations (ACOs) earning payments for their performance. This is the sixth...

CMS Reduces No Surprises Act Fee After Court Vacates Price Hike

by Jacqueline LaPointe

CMS has reinstated the $50 fee for initiating a payment dispute under the No Surprises Act following a court ruling striking down a price hike earlier this year. The non-refundable administrative fee...

Inpatient Providers Will Receive 3.1% Reimbursement Increase in FY24

by Victoria Bailey

CMS has increased Medicare payment rates for inpatient providers and long-term care hospitals (LTCHs) in the fiscal year (FY) 2024 Medicare hospital inpatient prospective payment system (IPPS) and LTCH...

CMS Increases 2024 Skilled Nursing Facility Payments by 4%

by Victoria Bailey

CMS has finalized a 4.0 percent increase in Medicare Part A payments to skilled nursing facilities (SNFs) in fiscal year (FY) 2024. The payment boost translates to $1.4 billion and is slightly higher...

CMS Boosts FY24 Payment Rates for Inpatient Psychiatric and Rehab Facilities

by Victoria Bailey

CMS has finalized payment increases for inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs). IPF Prospective Payment System The IPF prospective payment system (PPS)...

CMS Proposes Payment Cuts in CY24 Medicare Physician Fee Schedule

by Victoria Bailey

CMS has proposed payment cuts in its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS), including a 3.34 percent decrease to the conversion factor that would reduce payment rates by 1.25...

OPPS Rule to Update Outpatient Payments, Hospital Price Transparency

by Jacqueline LaPointe

CMS proposes in the Outpatient Prospective Payment (OPPS) rule to increase Medicare outpatient payments by 2.8 percent next year while bolstering hospital price transparency enforcement. The OPPS rule...

CMS to Resolve 340B Payment Mixup With $9B Lump-Sum Fix

by Jacqueline LaPointe

CMS has proposed to pay $9 billion to hospitals impacted by payment cuts to the 340B Drug Pricing Program between 2018 and 2022. The proposal is CMS’ remedy to cutting 340B payments from the...

CMS Proposes $375M Cut to Medicare Home Health Payments

by Jacqueline LaPointe

CMS has released the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule, which includes a 2.2 percent, or $375 million, cut to Medicare home health...

CMS Proposes 1.6% Payment Increase for ESRD Facilities

by Jacqueline LaPointe

CMS has released a proposed rule for the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. The...

Healthcare Spending to Pick Up Pace, Reaching $7.2T by 2031

by Jacqueline LaPointe

National healthcare spending slowed during the COVID-19 public health emergency (PHE) as the entire industry experienced severe disruptions to standard care. Now that the PHE has ended, healthcare...

CMS Primary Care Model Provides Value-Based Path for Practices

by Victoria Bailey

CMS will test a new primary care model in eight states with the hopes of improving patient care and increasing value-based opportunities for primary care organizations. The Making Care Primary (MCP)...

OIG: Medicare Overpayments Due to Coding Discrepancies Totaled $22.5M

by Victoria Bailey

Medicare improperly paid practitioners at a higher non-facility rate for services provided to skilled nursing facility (SNF) or hospital inpatients, leading to over $22 million in overpayments, a...

CMS Announces Start Date for IRF Claims Review Demo

by Jacqueline LaPointe

Inpatient rehabilitation facilities (IRFs) will have their Medicare claims reviewed either before or after payment as part of a demonstration CMS intends to take nationwide. CMS recently announced on...

Skilled Nursing Facility Use Increased Following PHE Waiver

by Victoria Bailey

Skilled nursing facility (SNF) episodes for Medicare beneficiaries without preceding acute care increased during the COVID-19 public health emergency (PHE), a study published in JAMA Internal Medicine...

HHS Sheds Light on Hospice, Home Health Ownership Data

by Jacqueline LaPointe

For the first time, HHS is releasing ownership data on all Medicare-certified hospice and home health agencies in an effort to increase transparency and competition in healthcare. HHS announced...

Lower Clinical Spending Needed in BPCI-A Program to Avoid Losses

by Victoria Bailey

Hospitals and physician groups participating in the Bundled Payments for Care Improvement Advanced (BPCI-A) program would have had to reduce clinical spending by 3.7 percent to 8.2 percent during the...

NAACOS Offers Guidance for Hybrid Primary Care Payment Model in MSSP

by Victoria Bailey

The National Association of ACOs (NAACOS) is calling on CMS to establish a hybrid primary care payment model in the Medicare Shared Savings Program (MSSP) using two possible approaches that will...

What Prior Authorization Changes in MA Final Rule Mean for Providers

by Victoria Bailey

CMS has released its 2024 Medicare Advantage (MA) and Part D Final Rule, which finalized policies on marketing oversight, prescription drugs, and prior authorization processes. Changes to prior authorization policies are particularly...

CMS Releases FY24 IPPS Proposed Rule, Seeks to Boost Rates by 2.8%

by Jacqueline LaPointe

CMS has released a proposed rule for the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS). The proposed rule would update hospital payment rates by 2.8 percent next fiscal year and...