Medicare Reimbursement

MGMA: Sustainable Financing Needed to Protect Rural Healthcare

by Jacqueline LaPointe

Physician and facility reimbursement for rural practices is not sustainable and is impacting patient access to rural healthcare, the Medical Group Management Association (MGMA) tells Congress in a new...

Healthcare Orgs Address Price Transparency, 340B Policies in OPPS

by Victoria Bailey

Hospital and specialty groups are urging CMS to amend aspects of the CY 2024 Outpatient Prospective Payment System (OPPS) proposed rule, including 340B Drug Pricing Program policies and price...

Provider Groups Oppose Proposed Payment Cuts in Physician Fee Schedule

by Victoria Bailey

Provider organizations have made it clear they are not happy with the payment cuts CMS proposed in the 2024 Medicare Physician Fee Schedule (PFS). Additionally, groups have voiced concerns about...

NAACOS: Medicare Payment Incentives Favor Clinicians in Fee-For-Service

by Victoria Bailey

Medicare payment incentives favor clinicians participating in fee-for-service models rather than those in advanced alternative payment models (APMs), according to the National Association of...

AHA Opposes Proposed Payment Cuts for Home Health Providers

by Victoria Bailey

The American Hospital Association (AHA) is urging CMS to reconsider the payment cuts included in the CY 2024 Home Health Prospective Payment System (PPS) proposed rule. Specifically, the trade...

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 Will Test APM for Medicare Beneficiaries with Dementia, Caregivers

by Victoria Bailey

CMS has announced plans to test an alternative payment model (APM) to support Medicare beneficiaries with dementia and their unpaid caregivers. The Guiding an Improved Dementia Experience (GUIDE)...

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...

Hospitals with Health Equity Factors Face Value-Based Penalties

by Jacqueline LaPointe

Hospitals with more medically complex patients, uncompensated care, and patients who live alone are more likely to receive a penalty under CMS value-based payment programs, according to a new study...

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...

AHA Decries Inpatient Prospective Payment System Update

by Jacqueline LaPointe

The proposed market basket update in the Inpatient Prospective Payment System (IPPS) for the 2024 fiscal year (FY) is “woefully inadequate,” according to the American Hospital Association...

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...

What the End of the COVID-19 PHE Means for Healthcare Providers

by Victoria Bailey

The COVID-19 public health emergency (PHE) has officially ended, and with it, so have policies that helped healthcare providers navigate challenging circumstances, including provider relief funds and...