Policy & Regulation News

Eye Specialists Pay $17M to Resolve False Claims Act Violations

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SouthEast Eye Specialists, SouthEast Eye Surgery Center, and the Eye Surgery Center of Chattanooga (SEES) must pay $17 million to the United States and Tennessee to resolve allegations that they...

HHS to Start Unwinding COVID-19 Vaccine Requirement

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HHS and DHS are starting the process of ending the COVID-19 vaccine requirement for CMS-certified healthcare facilities, as well as Head Start educators and certain noncitizens at the borders. The...

CMS Cracks Down on Hospital Price Transparency Compliance

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CMS is cracking down on hospital price transparency compliance — or lack thereof. The federal agency announced yesterday updated enforcement procedures, including earlier and automatic civil...

HHS Sheds Light on Hospice, Home Health Ownership Data

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For the first time, HHS is releasing ownership data on all Medicare-certified hospice and home health agencies in an effort to increase transparency and competition in healthcare. HHS announced...

House Oversight Panel Investigates COVID-19 Relief Allocation

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House Committee on Oversight and Accountability Chairman James Comer (R-KY) and Representative Nick Langworthy (R-NY) recently launched an investigation into how HHS allocated COVID-19 relief funds to...

CMS Releases FY24 IPPS Proposed Rule, Seeks to Boost Rates by 2.8%

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CMS has released a proposed rule for the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS). The proposed rule would update hospital payment rates by 2.8 percent next fiscal year and...

Lawmakers Want to Tie Physician Payment Updates to Inflation

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Several lawmakers are seeking to tie physician payment updates in Medicare to inflation to prevent potential physician shortage issues. Representatives Raul Ruiz, MD (D-CA-25), Larry Bucshon, MD...

CMS Proposes a 3.7% Boost in Skilled Nursing Facility Payments

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CMS has issued a proposed rule that includes a 3.7 percent payment update for skilled nursing facilities (SNFs) and changes to the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing...

Proposed Rule to Boost Medicare Inpatient Rehab Payments by 3%

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A new proposed rule from CMS would increase payments to inpatient rehabilitation facilities (IRFs) by $335 million next fiscal year. The draft regulation would also update quality reporting and new...

AHA, AHIP Urge Supreme Court to Uphold False Claims Act Ruling

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The American Hospital Association (AHA) and AHIP have filed an amicus brief challenging the federal government’s interpretation of the False Claims Act, stating that it would adversely impact...

CMS Proposes 2.8% Medicare Hospice Payment Bump

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Medicare hospice payments could grow by as much as 2.8 percent, or $720 million, next year under a rule recently proposed by CMS. The federal agency released the proposed rule on Friday. It seeks to...

CMS Resumes IDR Payment Determinations Under No Surprises Act

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CMS has instructed certified independent dispute resolution (IDR) entities to resume payment determinations for disputes involving items or services furnished on or after Oct. 25, 2022, according to...

AMGA Opposes Proposed Medicare Advantage Coding Changes

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AMGA has asked CMS not to finalize the coding changes included in the 2024 Medicare Advantage Advance Notice that would revise diagnoses and condition categories in the hierarchical condition...

CMS Proposes to Implement Changes to Medicaid DSH Calculations

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CMS has proposed a rule to update the regulatory requirements of the Disproportionate Share Hospital (DSH) program in response to the Consolidated Appropriations Act of 2021, including implementing...

AMA Urges CMS to Finalize Medicare Advantage Prior Authorization Reforms

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The American Medical Association (AMA) and 118 other medical organizations have urged CMS to finalize its proposed prior authorization reforms for the Medicare Advantage program. In a letter to CMS...

CMS Awards 200 Residency Slots to Bolster Healthcare Workforce

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CMS has awarded 200 Medicare-funded residency slots to support hospitals in underserved communities, according to a recent announcement. The awards are part of a larger push to provide 1,000 physician...

HHS Releases Ownership Data on All Medicare-Certified Hospitals

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HHS is releasing ownership data on all Medicare-certified hospitals in a bid to promote competition in a highly consolidated industry. “At President Biden’s direction, this Administration...

Congress to Halve Medicare Payment Cuts Via Year-End Spending Package

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Lawmakers unveiled the $1.7 trillion year-end spending package early this morning, which is expected to avert a government shutdown by Friday if both chambers can pass the measure this week. The...

National Healthcare Spending Grows 2.7% as COVID-19 Relief Runs Dry

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National healthcare spending is slowing down in the US compared to a significant 10.3 percent increase in 2020. However, healthcare costs remain high as US health expenditures reach $4.3...

Providers Leaving No Stone Unturned to Stop Medicare Payment Cuts

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Healthcare industry groups representing over 1 million physicians and other clinicians have joined together to urge Congress to prevent a 4.5 percent Medicare payment cut starting Jan. 1,...