CMS

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...

CMS Hospital At Home Model Seeks to Boost Capacity During COVID-19

by Jacqueline LaPointe

As many hospitals near capacity during another surge of COVID-19, CMS is allowing some healthcare providers to participate in a new hospital at home program that allows them to deliver acute care...

New ICD-10 Codes, MS-DRG Assignments for COVID-19 Coming Jan. 1

by Jacqueline LaPointe

Come January 1, 2021, CMS will implement 21 new ICD-10 procedure codes for COVID-19 vaccines and therapeutics for the novel coronavirus, including baricitinib and monoclonal antibody treatments. The...

Medicare FFS Improper Payments Down by $15B Since 2016

by Jacqueline LaPointe

Aggressive corrective actions aimed at reducing Medicare fee-for-service (FFS) improper payments have resulted in less healthcare fraud, waste, and abuse, as well as $15 billion in savings, according...

CMS Details Medicare Payment for New COVID-19 Antibody Drug

by Jacqueline LaPointe

Just a day after the FDA approved the emergency use of a new COVID-19 antibody drug, CMS updated Medicare payment and billing policies to ensure providers have access to the new treatment for...

Deadline to Provide Billing Info for Advance APM Bonus Approaches

by Jacqueline LaPointe

UPDATE 11/20/2020: CMS has extended the deadline to update billing information for APM incentive payments to December 13, 2020.  Eligible clinicians who CMS has notified as having missing billing...

51 Organizations Join New Direct Contracting Opportunity from CMS

by Jacqueline LaPointe

CMS recently announced that 51 organizations will take part in a new directing contracting opportunity that will test what the agency calls the “next evolution of risk-sharing...