CMS

CMS Delays CHART Model’s ACO Transformation Track

by Jacqueline LaPointe

CMS has pushed back the application cycle by a year for a new rural-focused accountable care organization (ACO) model. In an email sent yesterday, CMS said it has delayed the request for applications...

CMS Announces 184 Participants For ET3 Model, New Funding

by Jacqueline LaPointe

CMS has shared the final list of 184 public and private ambulance providers and suppliers selected to participate in the agency’s Emergency Triage, Treat, and Transport (ET3) Model, an...

CMS Boosts Medicare Reimbursement for COVID-19 Vaccinations

by Jacqueline LaPointe

UPDATED 03/16/21 CMS has significantly increased Medicare reimbursements rates for the administration of new COVID-19 vaccines in an effort to accelerate rollout, according to a new...

Biden Administration Pauses Key Value-Based Reimbursement Models

by Jacqueline LaPointe

The Biden administration has paused several prominent value-based reimbursement models run by the CMS Innovation Center (CMMI) to review model details, according to several updates provided on model...

Hospital Risk Stratification Leads To Equitable Value-Based Payment

by Hannah Nelson

When hospitals in the Hospital-Acquired Condition Reduction Program (HACRP) were stratified by social risk, value-based penalties for safety-net hospitals decreased, according to a new study published...

AHA Decries UnitedHealthcare’s Diagnostic, Drug Coverage Policies

by Jacqueline LaPointe

The American Hospital Association (AHA) is seeking immediate relief from UnitedHealthcare’s new benefit design program that would restrict in-network diagnostic providers. The hospital group...

Spotlight on the Biden Administration’s Healthcare Team

by Jacqueline LaPointe

Healthcare remains one of the top priorities for the Biden administration as it inherits an ongoing pandemic and the unstable future of the Affordable Care Act. But the President is already unveiling...

CMS Failed to Flag Medicare Fee-for-Service Healthcare Fraud, Waste

by Hannah Nelson

The Centers for Medicare & Medicaid Services (CMS) and its contractors did not use Comprehensive Error Rate Testing (CERT) data to identify healthcare fraud or waste, according to a new Office of...

A New Administration, Value-Based Payment to Dictate 2021 Success

by Jacqueline LaPointe

2021 may not have started as the fresh page everyone was hoping for, but a new administration could be making some well-worn strategies more relevant. In a new Healthcare Strategies podcast, the...

CMS Cost Reporting Delayed as Hospitals Question Proposed Changes

by Jacqueline LaPointe

CMS has delayed the filing deadline for cost reports by two months for most healthcare organizations because of the ongoing COVID-19 pandemic. The agency posted in a COVID-19 Frequently Asked...

Seema Verma Resigns as CMS Administrator Ahead of Biden Inauguration

by Jacqueline LaPointe

Seema Verma announced on her Twitter today that she is resigning as CMS Administrator in preparation for a new Medicare and Medicaid leader coming in next week under the Biden...

CMS Defines “Reasonable and Necessary” Medicare Coverage

by Jacqueline LaPointe

CMS has codified how it defines “reasonable and necessary” coverage for items and services that may be covered under Medicare Parts A and B in a new final rule. The rule finalized on Jan....

CMS to Reprocess Some Outpatient Claims After Site-Neutral Ruling

by Jacqueline LaPointe

CMS has announced that it will reprocess hospital outpatient claims from last year for clinic visit services provided at excepted off-campus provider-based departments. The agency will start...

CMS to Expand Home Health Value-Based Purchasing Model

by Jacqueline LaPointe

CMS is planning to expand a value-based purchasing model that rewards home health agencies for high-quality care and saves Medicare money. The federal agency announced on Jan. 8 via email that it...

CMS Recalculates Medicare Physician Fee Schedule Rates for 2021

by Jacqueline LaPointe

CMS has updated Medicare Physician Fee Schedule rates for 2021 after a COVID-19 stimulus package mitigated budget neutrality cuts finalized in a December rule. The Consolidated Appropriations Act,...

CMS to Audit Some Hospitals for Price Transparency Compliance

by Jacqueline LaPointe

CMS is taking steps to ensure hospitals comply with a controversial price transparency rule taking effect on January 1, 2021. On that date, every hospital in the country is expected to provide...

CMS Provides Billing Codes for Regeneron’s COVID-19 Antibody Drug

by Jacqueline LaPointe

CMS has released Medicare billing codes for a new COVID-19 antibody drug recently approved by the FDA. Healthcare providers are now able to use the Healthcare Common Procedural Coding System (HCPCS)...

CMS Announces A New Value-Based Direct Contracting Model

by Jacqueline LaPointe

A new direct contracting model from CMS will test whether a geographic-based approach to value-based care can improve quality of care while reducing costs for Medicaid beneficiaries in a specific...

CMS Releases 2021 OPPS Final Rule, Eliminates Inpatient Only List

by Jacqueline LaPointe

CMS has released the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule for 2021 in an effort to give Medicare beneficiaries more choices around surgical...

CMS Finalizes 2021 Physician Fee Schedule, Including E/M Changes

by Jacqueline LaPointe

After some delay due to the COVID-19 pandemic, CMS has released the final rule for the 2021 Medicare Physician Fee Schedule. The final rule unveiled by CMS yesterday evening will dictate how much...