Tag Archives: provider reimbursement

IPPS Proposed Rule Increases Hospital Payment; Solicits Ideas for Achieving Transparency, Relieving Administrative Burden

The Centers for Medicare & Medicaid Services (CMS) recently issued its proposed rule updating fiscal year (FY) 2018 payment policies and rates under the Medicare inpatient prospective payment system (IPPS). As highlighted below, the proposed rule aims to reduce regulatory burdens for providers and to promote transparency and flexibility in the delivery of care. Comments … Continue Reading

FY 2017 IPPS Proposed Rule Results in Modest Increase for Hospitals

CMS recently issued a proposed rule updating fiscal year (FY) 2017 Medicare payment policies and rates under the Medicare inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment system. Highlights of the proposed rule applicable to IPPS hospitals are the focus of this summary. With the proposed rule, CMS continues to emphasize its … Continue Reading

CMS Continues Its Focus on Quality Initiatives with the FY 2016 IPPS Final Rule

On July 31, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a final rule (Final Rule) updating fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System. While many hospitals will see increased Medicare reimbursement rates based on … Continue Reading

CMS Releases CY 2016 OPPS Proposed Rule With Updates to Two-Midnight Rule and Other IPPS Proposals

On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2016 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) payment system proposed rule that updates payment policies and rates for hospital outpatient departments and ASCs. The proposed rule also includes certain proposals relating to the hospital inpatient prospective … Continue Reading

2015 Medicare OPPS and ASC Final Rule

On November 10, 2014, the Centers for Medicare and Medicaid Services (CMS) published the Outpatient Prospective Payment System (OPPS) final rule for 2015. The rule updates CMS’s payment rates and policies, value-based purchasing measures and quality measures for services furnished in hospital outpatient departments and ambulatory surgical centers (ASCs) effective as of January 1, 2015. … Continue Reading

Federally Qualified Health Centers: Welcome to PPS

The Centers for Medicare & Medicaid Services (CMS) recently finalized a new prospective payment system (PPS) for Federally Qualified Health Center (FQHC) services. The implementation of the PPS was mandated by the Affordable Care Act (ACA). Medicare currently pays FQHCs an all-inclusive rate for the professional component of qualified primary and preventive health services furnished to the … Continue Reading

Never Fear Regulatory Violations – Focus on Conditions to Payment

The U.S. Court of Appeals for the Fourth Circuit recently upheld the dismissal of a False Claims Act (FCA) suit against Omnicare, Inc., in which the relator alleged that certain drugs repackaged by Omnicare’s subsidiary were adulterated and ineligible for Medicare or Medicaid reimbursement because of Food and Drug Administration (FDA) regulation violations and that … Continue Reading

CMS Announces Changes to RAC Program; Temporary Pause in Document Requests

The Centers for Medicare & Medicaid Services (CMS) recently published an announcement indicating that the agency is “in the procurement process for the next round of Recovery Audit Program Contracts” and is winding down its current contracts to enable Recovery Auditors to complete all outstanding claim reviews and other processes by the end date of existing … Continue Reading
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