CMS

CMS Seeks Input on National Directory of Healthcare Providers

by Jacqueline LaPointe

CMS is looking for stakeholder feedback on establishing the first, national directory of healthcare providers and services, according to an unpublished Federal Register notice. In the request for...

OIG: CMS System Edits Reduced Medicare Overpayments to Hospitals

by Victoria Bailey

CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the Office of...

Biden Administration Releases Data on Nursing Home Ownership

by Victoria Bailey

The Biden-Harris Administration has released additional Medicare nursing home ownership data to help boost nursing home transparency, safety and quality, and accountability. The publicly available...

Healthcare Compliance Will Be a Challenge in Post-PHE World

by Victoria Bailey

The COVID-19 public health emergency (PHE) declaration was accompanied by several waivers and flexibilities that made it easier for healthcare providers to care for patients amid a global pandemic. Expanded telehealth coverage, Stark Law...

MGMA Calls for Prior Authorization Reform in Medicare Advantage

by Victoria Bailey

The Medical Group Management Association (MGMA) has urged CMS to implement policies that support prior authorization reform and value-based care contracts within the Medicare Advantage program. MGMA...

Shared Savings Program ACOs Cut Costs Again, With 58% Earning Payouts

by Jacqueline LaPointe

Over half of Shared Savings Program ACOs earned payments for their quality and cost performance in 2021, according to new data from CMS. The federal agency reports that ACOs in the Medicare Shared...

APMs Support Better Primary Care, But Value-Based Care Obstacles Remain

by Jacqueline LaPointe

Primary care practices in Medicare’s Comprehensive Primary Care (CPC) and CPC+ models made meaningful care delivery changes compared to non-participating practices, making the case for...

CMS Delays Radiation Oncology Model With No New Start Date

by Jacqueline LaPointe

The Radiation Oncology Model has been delayed indefinitely under a final rule released by CMS on Thursday. The alternative payment and care delivery model for cancer care aims to improve quality of...

AHA Voices Concerns About Home Health Medicare Reimbursement Update

by Victoria Bailey

The American Hospital Association (AHA) has urged CMS to reconsider the Medicare reimbursement update for home health agencies proposed in the Calendar Year 2023 Home Health Prospective Payment System...

CMS Releases Guidance on Independent Dispute Resolution Process

by Victoria Bailey

CMS has launched a webpage containing resources and guidance regarding the federal independent dispute resolution (IDR) process under the No Surprises Act. The process helps determine reimbursement...

CMS Urges States to Tie Nursing Home Medicaid Payment to Quality

by Jacqueline LaPointe

CMS is pushing for more value-based reimbursement, this time for nursing home Medicaid payment. The federal agency has sent an informational bulletin to states urging them to tie Medicaid payments for...

CMS Offers Provider Resources for Public Health Emergency Ending

by Victoria Bailey

CMS has released guidance to help healthcare providers prepare for the eventual end of the COVID-19 public health emergency (PHE) and the accompanying waivers and flexibilities. When the pandemic hit,...

CMS Suspends Certificates of Medical Necessity, DME Forms for 2023

by Victoria Bailey

CMS has announced that it will no longer require healthcare stakeholders to submit Certificates of Medical Necessity (CMNs) or Durable Medical Equipment (DME) Information Forms (DIFs) for service...

Will Medicare Physician Fee Schedule Changes Drive Value-Based Care?

by Victoria Bailey

The proposed changes in the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2023 may offer incentives for provider groups to consider alternative payment models. Still, the policies will likely require more apparent benefits...

CMS Nixes MIPS Facility-Based Scoring for 2022 Performance Year

by Jacqueline LaPointe

Facility-based scoring in the Merit-Based Incentive Payment System (MIPS) will not be available for the 2022 performance year after recent changes to the Hospital Value-Based Purchasing (VBP) Program,...

MGMA Requests Longer Notice Before Surprise Billing Enforcement

by Victoria Bailey

The Medical Group Management Association (MGMA) has asked CMS and HHS to provide medical group practices with at least six months’ notice before enforcing any additional surprise billing...

OIG: CMS Reported Collecting Only Half of Medicare Overpayments

by Victoria Bailey

CMS reported collecting only half of the $498 million in Medicare overpayments identified by the Office of Inspector General (OIG), according to an OIG audit. The OIG audit was a follow-up to a...

CMS Final Rule Boosts Medicare Payments for Skilled Nursing Facilities

by Victoria Bailey

CMS has finalized a 2.7 percent increase in Medicare payments for skilled nursing facilities (SNFs) in its SNF Prospective Payment System (PPS) final rule for fiscal year 2023. The $904 million...

FAH Asks HHS, CMS to Extend COVID-19 PHE, Regulatory Waivers

by Victoria Bailey

The Federation of American Hospitals (FAH) has urged HHS to extend the COVID-19 public health emergency (PHE) into 2023, stressing that hospitals across the country still rely on the accompanying...

CMS Releases FY23 Final Rules for Hospice Providers, IPFs, IRFs

by Victoria Bailey

CMS has released final rules solidifying Medicare reimbursement rates for hospice providers, inpatient psychiatric facilities (IPFs), and inpatient rehabilitation facilities (IRFs) for fiscal year...