Medicare Reimbursement

Coalition Urges CMS to Rethink Medicare Prior Authorization Growth

by Jacqueline LaPointe

A broad coalition of healthcare industry groups is calling on CMS to reconsider Medicare prior authorization growth among outpatient services set to go into effect this summer. The 40 groups...

CMS Plans 1.3% Medicare Payment Hike for Skilled Nursing Facilities

by Jacqueline LaPointe

CMS has proposed a $444 million increase in Medicare payments to skilled nursing facilities (SNFs) in the federal fiscal year (FY) 2022, according to a new proposed rule. The rule released late...

CMS Proposes Medicare Payment Bump for Rehab, Psychiatric Facilities

by Jacqueline LaPointe

CMS has released the proposed rules for the Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the Inpatient Psychiatric Facility Prospective Payment System for fiscal year (FY)...

OIG Asks Hospital for $23.6M Back After Medicare Billing Errors

by Jacqueline LaPointe

The Office of the Inspector General has identified $23.6 million in overpayments reimbursed to a Nevada-based hospital, resulting from years of Medicare billing errors. In a report released on April...

CMS Starts Recouping Accelerated, Advance Medicare Payments

by Jacqueline LaPointe

CMS has started recouping Medicare payments it fronted to healthcare providers last year during the COVID-19 pandemic. In a recent MLN Matters newsletter, the agency stated that it has begun...

Hospital Outpatient Payment Would Suffer If 340B Cuts Reversed

by Jacqueline LaPointe

Outpatient payments would decrease for the majority of hospitals if HHS reversed a controversial policy reducing 340B drug reimbursement, according to a new Avalere analysis. The analysis examined...

AHA Asks CMS to Rescind Site-Neutral Payment Exception Denials

by Jacqueline LaPointe

The American Hospital Association (AHA) is calling on CMS to rescind recent audit determinations that lowered Medicare reimbursement to site-neutral payment rates for certain off-campus provider-based...

Providers Try to Stave Off Looming Medicare Spending Cuts

by Jacqueline LaPointe

UPDATED The American Medical Association (AMA) has urged Congress to prevent pending Medicare spending cuts triggered by the latest COVID-19 relief plan. In a March 16 letter to House Speaker...

Hospital Medicare Payments Dwarf Surgical, Add to Price Hikes

by Hannah Nelson

Even as length of stay decreased for hip fracture patients, the disparity between Medicare reimbursements to hospitals and reimbursements to surgeons has grown in recent years for this procedure,...

2% Hospital Reimbursement Hike, Other 2022 MedPAC Recommendations

by Jacqueline LaPointe

In its annual March report to Congress, the Medicare Payment Advisory Commission (MedPAC) has recommended a 2 percent increase in Medicare hospital reimbursement rates in 2022 and no update for...

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...

New Bill Seeks to Extend Medicare Sequester Moratorium

by Jacqueline LaPointe

UPDATED 04/16/2021 A bill is seeking to prevent across-the-board spending cuts triggered by the latest COVID-19 relief package, including the 2 percent Medicare sequester reduction, known as...

MA Reimburses 2X Medicare Rate for Some COVID-19 Vaccinations

by Jacqueline LaPointe

Healthcare providers in Massachusetts are getting twice the standard Medicare rate for COVID-19 vaccinations in an effort to accelerate vaccine rollout, according to a recent provider bulletin from the...

Skilled Nursing Facility Staffing Impacted by New Payment Rules

by Jacqueline LaPointe

Skilled nursing facility (SNF) staffing levels across several provider types have fallen since Medicare implemented new payment rules meant to drive value over volume of services, according to a new...

AMA: Medicare Sequester Threatens Physician Practice Viability

by Jacqueline LaPointe

As Congress gets ready to pass another COVID-19 stimulus package this week, physicians are once again calling on lawmakers to consider extending the moratorium of the Medicare sequester in a bid to...

Major Physician Reimbursement Gap for Independent Versus Hospital Docs

by Jacqueline LaPointe

Physician reimbursement for services performed by a doctor working for a hospital or health system is significantly higher than that paid to independent physicians for the same services, according to a...

Physician Specialties Hit Hardest by Medicare Spending in 2020

by Jacqueline LaPointe

Medicare spending on physician services decreased by $9.4 billion, or 19 percent, in the first half of 2020 because of the COVID-19 pandemic, according to a new analysis from the American Medical...

Reimbursing at Medicare Rates to Cut Healthcare Spending by $352B

by Jacqueline LaPointe

Healthcare spending would be about $352 billion lower in 2021 if private payers reimbursed providers at Medicare rates, according to a new analysis from Kaiser Family Foundation. The analysis of data...

Biden Administration Recommits to COVID-19 Reimbursement

by Jacqueline LaPointe

The Biden administration will provide COVID-19 reimbursement to clinicians vaccinating uninsured patients, according to new CMS guidance. The guidance released on Feb. 26, 2021, stated that providers...

CMS: Automatic Exception for MIPS Eligible Clinicians in 2020

by Jacqueline LaPointe

Individual clinicians who must participate in Medicare’s Merit-Based Incentive Payment System (MIPS) for the 2020 performance period will automatically have the extreme and uncontrollable...