Medicare Reimbursement

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...

Hospitals Increasingly Billing Inpatient Stays at Highest Severity

by Jacqueline LaPointe

A new report from the HHS Office of the Inspector General (OIG) has shown that hospitals have increasingly billed inpatient stays at the highest severity level, causing concern about Medicare...

Groups Want Medicare Sequester Moratorium Through End of PHE

by Jacqueline LaPointe

Healthcare organizations from across the care continuum are calling on Congress to act before the moratorium on the 2 percent Medicare sequester expires on Mar. 31, 2021. Congress has paused the...

Medicare, Medicaid Payments Off Actual Costs By $75.8B in 2019

by Jacqueline LaPointe

Hospitals received just 87 cents for every dollar they spent caring for Medicare patients and 90 cents for every dollar on Medicaid patients in 2019, according to new data from the American Hospital...

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 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,...

OIG: Direct Wage Index Increases to Low-Margin Rural Hospitals

by Jacqueline LaPointe

Rural hospitals struggling the most financially are not benefitting from a Medicare reimbursement adjustment meant to help providers paying the lowest wages to their employees, according to a new...

Providers, Lawmakers Say #StopTheCuts to Physician Fee Schedule

by Jacqueline LaPointe

With payment reductions looming for many providers paid under the Medicare Physician Fee Schedule, hundreds of medical organizations and lawmakers are pushing Congress to stop rate cuts finalized in...

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)...

Hospitals Criticize Major Policy Moves in 2021 OPPS Final Rule

by Jacqueline LaPointe

Healthcare policies designed to boost competition between hospital outpatient departments and physician offices could actually end up harming hospitals during one of the worst financial crises to hit...

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...

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...