Medicare Reimbursement

CMS Proposes 2.7% Increase in CY23 OPPS, ASC Reimbursement Rates

by Victoria Bailey

CMS has released its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, which includes a 2.7 percent...

Providers Face Cuts in Medicare Physician Fee Schedule Proposed Rule

by Jacqueline LaPointe

CMS has proposed a decrease to the Medicare Physician Fee Schedule conversion factor, which would lead to significant cuts to physician reimbursement next year. The federal agency released the...

AHA Calls for Timely Repayment to 340B Hospitals After Unlawful Cuts

by Victoria Bailey

The American Hospital Association (AHA) has asked HHS to ensure 340B hospitals receive timely repayment following the Supreme Court’s decision that the department’s 340B Medicare...

Safety-Net Hospitals Lose Challenge of Medicare DSH Payment Rule

by Jacqueline LaPointe

In a narrow ruling, the Supreme Court recently sided with HHS in a case challenging a multi-billion dollar cut to Medicare payments to safety-net hospitals. The Court ruled 5 to 4 that HHS did have...

Private Capital Investments May Help Sustain Skilled Nursing Facilities

by Victoria Bailey

Skilled nursing facilities need private capital investments to support innovation that will allow them to continue providing care to older adults, according to an ATI Advisory analysis commissioned by...

CMS Rule to Update ESRD Medicare Reimbursement, New Care Model

by Jacqueline LaPointe

CMS recently proposed the Calendar Year 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule, which would boost Medicare reimbursement for ESRD facilities and refine a new...

AHA Responds to Proposed FY23 Hospital IPPS Payment Updates

by Victoria Bailey

The American Hospital Association (AHA) has asked CMS to make several adjustments to the proposed Hospital Inpatient Prospective Payment System (IPPS) payment updates for fiscal year 2023, including...

CMS Proposes New Medicare Payment Adjustment for Home Health

by Jacqueline LaPointe

CMS is looking to apply a permanent prospective payment adjustment to the home health 30-day period payment rate to account for changes resulting from the implementation of the Patient-Driven Groupings...

Medicare, Beneficiaries Saw Higher Prices at Provider-Based Facilities

by Victoria Bailey

Medicare and its beneficiaries paid significantly higher prices at provider-based facilities than they would have paid to freestanding facilities for the same services, according to a report from the...

Hospitals Win Supreme Court Case on 340B Reimbursement Cuts

by Victoria Bailey

The US Supreme Court has sided with the American Hospital Association (AHA) and other hospital groups and determined that the 340B Medicare reimbursement cuts for hospitals were unlawful. In the 2018...

AHA Opposes Proposed Payment Cut for Skilled Nursing Facilities

by Victoria Bailey

The American Hospital Association (AHA) has urged CMS not to cut Medicare payments for skilled nursing facilities in fiscal year 2023, as the agency put forth in its Skilled Nursing Facility (SNF)...

Eliminating Indirect Billing for NPs, PAs Could Save Medicare $194M

by Victoria Bailey

If healthcare practices eliminated indirect billing for nurse practitioner (NP) and physician assistant (PA) visits, it would have saved Medicare $194 million in 2018, according to a Health Affairs...

AHA Calls for Changes to FY23 Inpatient Rehabilitation Facility PPS

by Victoria Bailey

The American Hospital Association (AHA) has asked CMS to adjust the final Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) rule for FY 2023, noting concerns about the proposed...

Hospital Prices 224% Higher for Private Payers than Medicare

by Victoria Bailey

On average, private payers paid hospitals 224 percent of what Medicare would have paid for the same inpatient and outpatient services, according to a report from the RAND Corporation. Researchers used...

Breaking Down Common CMS Value-Based Payment Programs

by Victoria Bailey

Value-based payment programs tie healthcare reimbursement rates to quality care by offering providers incentive payments to meet specified quality measures during and after healthcare delivery. As the industry moves away from...

CMS Proposes $1.6B Increase in IPPS Payment Rates for FY23

by Victoria Bailey

CMS has released its Hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year 2023, which includes a payment rate boost for general acute care hospitals and new measures...

DOJ Alleges Methodist Violated False Claims Act, Anti-Kickback Laws

by Victoria Bailey

The US Department of Justice (DOJ) has filed a lawsuit against Methodist Le Bonheur Healthcare and Methodist Healthcare Memphis Hospitals, alleging that the health systems violated the False Claims Act...

CMS Releases Skilled Nursing Facility PPS Proposed Rule for FY23

by Victoria Bailey

CMS has released its proposed Skilled Nursing Facility (SNF) Prospective Payment System (PPS) rule for fiscal year 2023, which includes a reduction in Medicare payments for SNFs. The proposed payment...

AHA Asks Congress Again for More COVID-19 Financial Relief

by Victoria Bailey

The American Hospital Association (AHA) has penned a letter to Congressional leaders, asking once again for additional COVID-19 financial relief for hospitals and health systems. The trade...

CMS Proposes 2.7% Payment Boost for Inpatient Psychiatric Facilities

by Victoria Bailey

CMS has issued a proposed Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) rule for FY 2023, which introduced an update to IPF Medicare payments and included comment requests on...