Medicare Reimbursement

CMS Releases Initial Quality Payment Program Results for 2019

by Jacqueline LaPointe

Eligible clinicians overwhelmingly participated in the Quality Payment Program despite facing challenges caused by the COVID-19 pandemic, according to preliminary data from CMS. CMS announced in a...

CMS Sets Medicare Reimbursement Rate for COVID-19 Vaccine

by Jacqueline LaPointe

A new interim final rule with comment period ensures Medicare reimbursement for the administration of a COVID-19 vaccine and provider use of innovative treatments for the novel coronavirus. The rule...

CMS Wants to Streamline DMEPOS Reimbursement, Boost Rural Pay

by Jacqueline LaPointe

A new proposed rule from CMS is seeking to streamline how the agency determines if durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) qualify for Medicare reimbursement and...

Lawmakers Seek Bipartisan Solution for Physician Fee Schedule Cuts

by Jacqueline LaPointe

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...

Court Denies Requests to Revisit 340B, Site-Neutral Payment Cases

by Jacqueline LaPointe

According to the American Hospital Association (AHA), an appeals court has declined to reconsider two decisions from the summer, which upheld Medicare reimbursement cuts for 340B drugs and for...

CMS Reduces Medicare Reimbursement Rate for Some COVID-19 Tests

by Jacqueline LaPointe

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

by Jacqueline LaPointe

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...

Senators Call for Changes to Provider Relief Fund Reporting

by Jacqueline LaPointe

Senators are raising issues with recent changes to Provider Relief Fund reporting requirements, citing concerns about hospitals having to return the payments during the ongoing public health...

Limited Reimbursement Paid Out for Uninsured COVID-19 Treatment

by Jacqueline LaPointe

A program designed to offset the costs of uninsured COVID-19 patients during the public health emergency has paid out limited reimbursement to providers, according to a recent report from the Kaiser...

Top 3 Concerns with the 2021 Medicare Physician Fee Schedule Rule

by Jacqueline LaPointe

Provider groups are concerned that some proposals in the Medicare Physician Fee Schedule rule for 2021 would exacerbate the financial challenges physicians are already facing during the COVID-19...

CMS Amends Repayment Terms for Accelerated, Advance Payments

by Jacqueline LaPointe

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...

Lawmakers Provide Accelerated, Advance Medicare Payment Relief

by Jacqueline LaPointe

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 to Expand Prior Authorizations for Certain Ambulance Transports

by Jacqueline LaPointe

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,...

Chronic Care Management Code Use Increases, But Uptake Still Lagging

by Jacqueline LaPointe

Providers are increasingly using chronic care management (CCM) codes to address care fragmentation issues for patients with multiple chronic conditions. However, utilization patterns among...

Telehealth Reimbursement Just for Value-Based Providers Post-COVID?

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) is the latest group to weigh telehealth reimbursement expansions after the COVID-19 pandemic. In a meeting held virtually last week, MedPAC analysts...

Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS

by Jacqueline LaPointe

Clinicians who served more patients with social risk factors such as low income performed worse in the Merit-Based Incentive Payment System’s inaugural payment year, and therefore, received...

OIG to Audit Medicare Payments for COVID-19 Discharges

by Jacqueline LaPointe

HHS’ Office of the Inspector General (OIG) will audit Medicare payments made to hospitals for COVID-19 discharges that qualified for a 20 percent add-on payment under the Coronavirus Aid, Relief,...

Closer Look at the Inpatient Prospective Payment System Final Rule

by Jacqueline LaPointe

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

by Jacqueline LaPointe

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...