Medicare Reimbursement

OIG: Improve Medicare rate-setting for clinical diagnostic lab tests

April 12, 2024 - CMS’ procedures for setting Medicare rates for clinical diagnostic lab tests could improve for future public health emergencies, according to a new report from the Office of the Inspector General (OIG). OIG said in the report that, during the COVID-19 public health emergency, current Medicare rate-setting procedures “did not allow the...


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CMS proposes payment increases for IPPS hospitals and LTCHs

by Victoria Bailey

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...

AMGA urges Congress to extend value-based care incentives, prevent pay cuts

by Victoria Bailey

The American Medical Group Association (AMGA) has urged congressional leaders to ensure provider stability by incentivizing value-based care, preventing additional Medicare payment cuts, and preserving...

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...

$460B spending bill averts shutdown, some physician pay cuts

by Jacqueline LaPointe

Congress narrowly avoided a partial government shutdown, sending a $460 billion spending bill to the President’s desk over the weekend. The bipartisan deal, passed by the House 339-85 last...

Hospital Groups Rally Against HHS’ Interpretation of DSH Payments Formula

by Victoria Bailey

The American Hospital Association (AHA) and five other hospital groups are calling on the Supreme Court to challenge the Department of Health and Human Services’ (HHS) interpretation of...

House Bill Addresses Price Transparency, Site-Neutral Payment Policies

by Victoria Bailey

The US House of Representatives has passed a bill to improve healthcare price transparency and establish site-neutral payment policies for drug administration. The Lower Costs, More Transparency Act...

Most Surgeons Earned MIPS Bonus Payments in 2021, Study Finds

by Victoria Bailey

Most surgical healthcare professionals participating in the Merit-based Incentive Payment System (MIPS) earned bonus payments in 2021, with urologists seeing the highest adjustment, a study published...

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...

Reducing Barriers to MIPS, Advanced APMs Could Promote Participation

by Victoria Bailey

Reducing barriers to Advanced Alternative Payment Model (APM) participation for physicians in rural areas could help promote value-based care and control rising Medicare spending, according to research...

Physician-Owned Hospitals Could Save Medicare Over $1B

by Jacqueline LaPointe

Physician-owned hospitals treated some of the most expensive Medicare beneficiaries at lower costs compared to traditional hospitals despite seeing similar patient populations, according to a recent...

Lower Payment Rates May Help Curb Medicare Spending on Post-Acute Care

by Victoria Bailey

As Medicare Part A is expected to become insolvent by 2033, Congress should reduce Medicare spending on post-acute care by lowering payment rates to skilled nursing facilities (SNFs), home healthcare...

Gender Pay Disparities in Medicare Reimbursement Impact Neurosurgeons

by Victoria Bailey

Gender pay disparities persisted for neurosurgeons between 2013 and 2020, with women receiving 44 percent less in annual payments than men, a study published in JAMA Surgery revealed. Researchers used...