Policy & Regulation News

Lawmakers Seek Bipartisan Solution for Physician Fee Schedule Cuts

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Over 200 Representatives are calling on Congress to examine possible bipartisan solutions to address proposed Medicare Physician Schedule cuts for certain specialties, including surgical care. In a...

CMS Reduces Medicare Reimbursement Rate for Some COVID-19 Tests

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CMS will reduce the base Medicare reimbursement rate for COVID-19 tests done by laboratories using high throughput technology, according to a new announcement. The announcement made late last week...

CMS Provides Medicare Reimbursement for More Telehealth During PHE

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CMS recently added 11 new services to the Medicare telehealth services list, qualifying the services for Medicare reimbursement through the COVID-19 public health emergency (PHE). The new telehealth...

CMS Amends Repayment Terms for Accelerated, Advance Payments

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UPDATED 10/14/2020 CMS recently announced new repayment terms for payments issued to providers under the Accelerated and Advance Payment Programs at the start of the COVID-19 public health...

CMS Releases Guidance on COVID-19 Data Reporting as Medicare CoP

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New guidance from CMS shares how the agency plans to implement a recent interim final rule that makes COVID-19 data reporting a condition of participation (CoP) in Medicare for hospitals. The guidance...

HHS Distributes Another $20B in Provider Relief Funds

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HHS recently announced new Phase 3 Provider Relief Funding for healthcare providers, including an expanded group of behavioral health providers. According to the announcement, HHS will begin...

Lawmakers Provide Accelerated, Advance Medicare Payment Relief

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A continuing resolution signed by President Trump early Thursday morning included key healthcare provisions, including an extension for providers who had their Medicare payments advanced during the...

CMS Streamlines CLIA Certification to Expand COVID-19 Testing

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CMS is seeking to expand COVID-19 testing by streamlining Clinical Laboratory Improvement Amendments (CLIA) certification and compliance. In an announcement late last week, the agency provided a...

White House Gives Congress Until Dec. 31 to Ban Surprise Billing

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UPDATED 09/30/2020 An executive order on a number of healthcare issues includes a new timeline for a surprise billing solution and further advancements in hospital price transparency. Signed by...

CMS to Expand Prior Authorizations for Certain Ambulance Transports

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CMS is expanding a program integrity payment model that saved Medicare $650 million by targeting inappropriate overuse of ambulance services using prior authorizations. In an announcement yesterday,...

HHS Releases Reporting Requirements for COVID-19 Relief Payments

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HHS recently released an updated guidance document on reporting requirements for healthcare organizations that received COVID-19 relief payments of $10,000 or more. The document released on the HHS...

Hospitals Wage War with Pharma Over 340B Drug Pricing Program Cuts

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The controversy surrounding the notorious 340B Drug Pricing Program continues with more than 1,100 hospitals now urging HHS to stop pharmaceutical companies from refusing discounts for drugs covered by...

Preparing for Hospital Price Transparency Rule Compliance

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A global pandemic may not be enough to stop one of CMS’ more controversial rules from taking effect in just a couple of months. On January 1, 2021, US hospitals will need to comply with the...

Closer Look at the Inpatient Prospective Payment System Final Rule

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Yesterday, CMS unveiled the highly anticipated Inpatient Prospective Payment System (IPPS) final rule for the 2021 fiscal year (FY). Chief among the rule’s updated policies is a 2.9 percent...

CMS Finalizes FY 2021 Inpatient Prospective Payment System Rule

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UPDATE 09/03/2020: For an in-depth analysis for the FY 2021 IPPS final rule, click here. CMS recently released the final FY 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and...

CMS Makes COVID-19 Data Reporting a Condition of Participation

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COVID-19 data reporting will no longer be voluntary for hospitals participating in Medicare and Medicaid programs, according to a new interim final rule from CMS. For more coronavirus updates, visit...

CMS Updates Medicare Billing Rules for 20% Add-On COVID-19 Payment

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Claims eligible for the 20 percent add-on payment for COVID-19 hospitalizations will now have to have a positive laboratory test documented in the patient’s medical record, according to recent...

CMS Doles Out $15M in Fines to Nursing Homes During COVID-19

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CMS recently announced that more than 3,400 nursing homes were fined because of noncompliance with infection control requirements and failure to report COVID-19 data during the public health...

Inpatient Rehabilitation Facility PPS Rule for FY 2021 Finalized

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CMS is making permanent some regulatory flexibilities offered to inpatient rehabilitation facilities during the COVID-19 public health emergency, according to a new rule. The Inpatient Rehabilitation...

CMS to Boost Outpatient Reimbursement, Remove Inpatient Only List

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Medicare outpatient payments are slated to increase by 2.6 percent next year, a $7.5 billion boost compared to 2020, according the proposed 2021 Outpatient Prospective Payment System (OPPS)...