Articles related to Reimbursement & Payment Practices

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CMS Issues Notice and Appeal Instructions to Hospitals That Reclassify Patients from Inpatients to Outpatients

[02/12/25]

CMS’s Interim Final Rule Abandons Low Wage Index Hospital Policy

[10/15/24]

Key Highlights from the 2025 Medicare Physician Fee Schedule Proposed Rule

[09/10/24]

CMS Releases Final Rule: Transforming Episode Accountability Model

[09/05/24]

CMS Releases 2025 IPPS Final Rule

[08/27/24]

HHS Cannot Exclude § 1115 Waiver Days from Medicare DSH Formula

[08/22/24]

Medicare Finalizes New Labor Market Areas Based on Census Data – Impact on Special Rural Status

[08/06/24]

Supreme Court Agrees to Hear Group Appeal Challenging DSH Reimbursement Policy

[06/14/24]

Hospitals’ Win in Challenge of Calculation of Nursing and Allied Health Pass-Through Reimbursement Affects Protests on Future Cost Reports

[05/23/24]

CMS Announces Proposed Rule: Transforming Episode Accountability Model “TEAM”

[05/10/24]

CMS Publishes Proposed Hospital and Long-Term Care Hospital FY 2025 IPPS Rate Updates

[04/22/24]

Medicare’s Proposed Updates to Labor Market Areas and Impact on Special Rural Status

[04/12/24]

CMS Imposes New Requirements on Payers to Improve Prior Authorization Process and Payer, Patient and Provider Communications

[03/20/24]

CMS Updates Cost Report e-Filing System (MCReF)

[01/24/24]

Buyer Beware: CMS Finalizes Ownership Disclosure Requirements for Medicare Skilled Nursing Facilities and Medicaid Nursing Facilities

[12/20/23]

Medicare Advantage Plans Must Follow the Two-Midnight Rule

[11/17/23]

Advanced Practice Professionals – Time to Review These Arrangements?

[11/15/23]

CMS Finalizes FFY 2024 Changes for Rural Floor Wage Index Policy

[08/10/23]

Medicare Exact Match Update: Provider Compliance Required Effective 8/1/2023

[07/28/23]

CMS Releases Repayment Proposal for 340B Payment Cuts

[07/07/23]

CMS Announces CY 2024 ESRD Proposed Rulemaking 

[07/05/23]

CMS Issues Final Rule for DSH Medicare Advantage Days Policy

[06/08/23]

CMS Releases FFY 2024 IPPS Proposed Rule; Proposed Change in Rural Floor Wage Index Policy & Wage Index Deadlines

[04/18/23]

Hospitals Have Until March 23 to Object to Release Provider Relief Fund High Impact Data

[03/14/23]

Proposed Ownership Disclosure Requirements for Medicare Skilled Nursing Facilities and Medicaid Nursing Facilities

[02/21/23]

The End Is Near – Stark Law Blanket Waivers Set to Terminate May 11

[02/20/23]

No Surprises Act Enforcement Begins

[02/20/23]

CMS Publishes RADV Audit Methodology and Intent to Recover Overpayments

[02/14/23]

CMS Proposes to Drastically Change Overpayment Refund Rule

[01/12/23]

Medicare Physician Fee Schedule for 2023: What Providers Need to Know

[12/30/22]

HHS Publishes Proposed Payments for Rural Emergency Hospitals

[08/01/22]

Supreme Court Decision Bodes Well for Hospitals Appealing DSH SSI Issue

[07/01/22]

CMS Releases FFY 2023 Proposed Rule; Proposed Cap on Wage Index Decreases & Wage Index Deadlines

[04/20/22]

Key Medicare Payment Policy Changes from the CMS CY 2022 MPFS Final Rule

[11/16/21]

Final Rule for 2022 OPPS/ASC Payment Addresses Price Transparency Penalties, Covered Procedures Criteria and Much More

[11/16/21]

Temporary Relief: Federal Government Defers Enforcement of Certain Transparency and Disclosure Requirements Under the No Surprises Act

[09/10/21]

CMS Releases FFY 2022 Proposed Rule, Triggers Wage Index and Reclassification Deadlines

[04/29/21]

Latest COVID-19 Relief Package Includes $8.5 Billion for Rural Providers

[03/19/21]

OMB Census Recommendations Could Have Huge Downstream Impacts on Medicare Payments

[03/08/21]

Federal Appeals Court Upholds Hospital Price Transparency Rule

[12/30/20]

Holiday Surprise for Health Care Providers: Spending Package Includes Surprise Billing Fix

[12/28/20]

UPDATE: Congress Delivers Legislative Relief to Provider Relief Fund Recipients

[12/22/20]

Medicare Payment for COVID-19 Vaccines and Antibody Therapy

[12/21/20]

CMS Finalizes 2021 MPFS Final Rule – 3 Key Policy Changes Impacting Flexibility for Non-Physician Practitioners

[12/16/20]

Pulling Back the Curtain: Final Rule Requires Payors to Disclose Rates

[12/02/20]

CMS Accepting Waiver Applications to Permit Hospital Care at Home

[11/30/20]

OIG Work Plan Deja Vu – OIG to Audit Short-Stay Inpatient Claims Again!

[11/30/20]

Provider Relief Fund FAQs: HHS Just Rewrote the Playbook

[10/30/20]

HHS Revises Provider Relief Fund Reporting Guidelines in Response to Stakeholder Concerns

[10/23/20]

CMS Finalizes New Mandatory Payment Model for ESRD Treatments

[10/19/20]

CMS Reducing Payment for COVID-19 Lab Testing

[10/16/20]

Provider Relief Fund Phase 3: 43 New FAQs & Instructions Posted

[10/07/20]

Additional $20 Billion Allocation – Apply Starting October 5; Payback Delay for Medicare Accelerated Payments

[10/01/20]

CMS Finalizes New Mandatory Radiation Oncology Payment Model

[09/29/20]

HHS Publishes Provider Relief Fund Detailed Reporting Guidelines: Where Did Lost Revenue Go?

[09/22/20]

FFY 2021 Inpatient PPS Final Rule Released by CMS

[09/04/20]

HHS Rolls Out Medicaid Targeted Distribution, Clarifies Quarterly Reporting Deadline and Updates Other FAQs

[06/26/20]

Court Rules that Hospital Price Transparency Requirements Can Take Effect

[06/26/20]

$175 Billion Health Care Relief Fund: How Much Is Left After New Medicaid/CHIP and Safety Net Hospital Payments Announced?

[06/12/20]

IMMEDIATE ACTION REQUIRED – HHS Requesting Updated COVID-19 Patient Data to Inform New Round of High Impact Payments

[06/10/20]

The FAQ Carousel: HHS Continues with More Updates to CARES Act Relief Fund FAQs

[06/01/20]

HHS Extends Deadline for Submitting Relief Fund Attestations (Again)

[05/23/20]

HHS Updates Its CARES Act Provider Relief Fund FAQs Again

[05/22/20]

IMMEDIATE ACTION REQUIRED – Upcoming CARES Act Relief Fund Deadlines and Latest Updates

[05/21/20]

CMS Releases FFY 2022 Wage Index Development Timetable

[05/15/20]

CMS Releases FFY 2021 Proposed Rule, Triggers Wage Index and Reclassification Deadlines

[05/14/20]

Did the Ground Just Shift? CMS Proposes Changes to Hospital Wage Index Areas

[05/13/20]

HHS Extends Deadline for Submitting Relief Fund Attestations

[05/07/20]

CMS Flexibilities for Billing Hospital Outpatient Therapeutic Services During the COVID-19 Public Health Emergency

[05/05/20]

New/Updated Terms and Conditions and Hall Render Briefing Document

[04/26/20]

HHS Relief Fund Payment Portal Now Open

[04/26/20]

New Provider Relief Fund Application Guide Website and FAQ Document

[04/26/20]

CARES Act Relief Funding: Additional Tranches Announced

[04/23/20]

Providers May Set Reimbursement Rates with Out-Of-Network Payors for COVID-19 Testing by Posting Rate to Website

[04/22/20]

Temporary Suspension of Medicare Sequestration and Increased DRG Payments Under the CARES Act: But What About Medicare Advantage?

[04/08/20]

CMS Activates Accelerated Payment Program Nationwide as Part of COVID-19 Response

[03/29/20]

Latest Stimulus Bill Includes Over $100 Billion in Health Care Industry Relief: Providers Should Start Preparing Now

[03/27/20]

Hospital Exact Match Claim Edits Further Delayed Amidst COVID-19 Pandemic

[03/25/20]

Deadlines Matter in Wage Index Case

[02/28/20]

Congress Delays Laboratory Data Reporting Requirements Until 2021

[01/16/20]

Key Takeaways from 2020 Hospital Outpatient Prospective Payment System Final Rule

[11/08/19]

MAC Attacks on the Rise for Allied Health Education Programs

[10/25/19]

Proposed CMS Hospital Survey Could Support CMS’s Efforts to Reduce 340B Drug Reimbursement

[10/07/19]

Hospitals Win Battle Over Site-Neutral Pay Cuts

[09/18/19]

CMS’s Reach May Be Limited in Bankruptcy Proceedings

[09/17/19]

Can Individuals and Hospitals Sue Wrongdoers Under the Medicare Secondary Payer Act?

[09/17/19]

CMS Finalizes New Anti-Fraud Tools Aimed at Affiliations

[09/10/19]

MIPS Targeted Review Request Deadline September 30

[09/05/19]

Reminder: Many Hospitals Will Be Required to Report Lab Price Data as Part of PAMA Changes

[09/03/19]

Allina Notice & Comment Requirement Trumps Bar to Review of Uncompensated Care Payments

[08/28/19]

Appropriate Use Criteria for Advanced Diagnostic Imaging – Testing Period Begins Soon!

[08/26/19]

CMS Finalizes Changes for Low Wage Hospitals and Rural Floor

[08/19/19]

Court Takes Broad View of Medicare DSH Eligibility for § 1115 Waiver Program Days

[08/09/19]

CMS Proposes Payment Policy Changes Impacting Hospital Outpatient Department Services – What You Need to Know

[08/02/19]

CMS Proposed Mandatory Payment Models for Radiation Oncology and ESRD

[07/22/19]

Location Matters Update: CMS Postpones Exact Match Billing Rule – AGAIN

[07/02/19]

Michigan Medicaid Implements New Enrollment and Billing Requirements for Clinical Nurse Specialists and Nurse Practitioners

[06/06/19]

Hospitals Win in Rare Supreme Court Decision Pertaining to Medicare Reimbursement

[06/03/19]

CMS Releases FFY 2021 Preliminary Public Use File and Wage Index Development Timetable

[05/22/19]

GAO Lab Report – Sound Analysis? Criticism from Senator Grassley and Others and CMS’s Response

[05/20/19]

CMS Updates Preclusion List Requirements for Medicare Advantage and Part D

[05/10/19]

CMS Announces New Primary Cares Initiative

[05/10/19]

Medicare Hospital Co-Location Fix? Not There Yet…

[05/07/19]

Wage Index Fix? CMS Proposes Changes for Low Wage Hospitals and Rural Floor

[04/30/19]

Medicare Paid Twice for Ambulance Services Subject to SNF Consolidated Billing

[04/19/19]

CMS Postpones Rules for Billing Off-Campus Provider-Based Departments Until July 2019

[03/29/19]

Location Matters: Get It Right or Don’t Get Paid

[03/06/19]

Claims Denials Start April 1: What You Should Know About CMS’s New Preclusion List

[02/15/19]

Affordable Health Care: Patients’ Co-Pays Waived by Charitable Pediatric Clinic

[02/12/19]

Clinical Diagnostic Labs Enter a New Collection and Reporting Period as Medicare Payment Updates Continue

[01/18/19]

Hospital Wage Index Reform Deja Vu? OIG Releases Report on Vulnerabilities of Wage Index System, Recommends Overhaul of System

[11/30/18]

Episode-Based Bundled Payment Models Poised to Make a Comeback

[11/16/18]

CMS Finalizes Several Changes for Off-Campus Provider-Based Clinics

[11/12/18]

CMS Proposes Major Change to Medicare Part B Drug Payment System Introducing International Pricing Index Model

[11/09/18]

OIG Audit Findings: Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Requirements (October 10, 2018)

[10/17/18]

CMS Proposes to Simplify Coding and Documentation Requirements for E/M Services but with a Catch

[09/28/18]

CMS Proposes Several Changes for Off-Campus Provider-Based Clinics

[08/03/18]

Graduate Medical Education Highlights: 2019 Inpatient Prospective Payment System Proposed Rule

[05/11/18]

CMS Proposes to Eliminate Written Physician Order Requirement as a Condition for Payment for Inpatient Admissions

[05/08/18]

CMS Releases FFY 2019 Proposed Rule, Triggers Wage Index and Reclassification Deadlines

[05/03/18]

Finally, a Permanent Fix to the Therapy Caps

[03/27/18]

Overreaching Edits Deactivated for CAH Method II Claims

[03/07/18]

CMS Guidance May Prevent Inpatient Rehabilitation Claim Denials

[03/05/18]

CMS Adopts National Targeted Probe and Educate Program

[02/06/18]

Medicare Therapy Caps – Expiration of Exception Processes and Applicability to Hospital Outpatient Services

[01/30/18]

D.C. Circuit: CMS Manuals Are Policy Statements, Not Binding Authority

[01/30/18]

Provider-Based Mid-Build Exception Starts to Pay Off for Hospitals

[01/15/18]

CMS Announces “BPCI Advanced”

[01/10/18]

Medicare 340B Payment Cuts Go Live as of January 1. What’s Next?

[01/05/18]

Federal Judge Denies Hospitals’ Motion to Enjoin Imminent 340B Program Payment Cuts

[12/30/17]

CMS Removes Total Knee Replacement from Inpatient-Only List 

[11/28/17]

Meaningful Use Hardship Exception Deadline Approaching

[09/14/17]

CMS Proposes Significant Changes to the CJR Model and the Cancellation of the AMI, CABG and SHFFT Episode Payment Models

[08/16/17]

Providers Victorious in DSH Medicare Advantage Days Case

[07/31/17]

Expect Increased Enforcement: CMS to Seek Refunds of Meaningful Use EHR Incentive Payments

[07/31/17]

CMS’s Unfounded “Theory of Relativity” – Major Payment Decrease Proposed for Non-Grandfathered Provider-Based Clinics

[07/24/17]

Getting Paid for Telehealth Services

[07/11/17]

Non-Network Employer Health Plans – The Struggle Continues

[07/07/17]

MACs Issue Revised Credentialing Guidance for Hospital Sleep Centers

[05/12/17]

Sleep Centers Wake Up to Medicare Accreditation Changes

[05/05/17]

CMS Establishes New Medicare Episode Payment Models

[12/21/16]

CMS Final Rule Implements Section 603 Limitations on Payment for Off-Campus Provider-Based Departments

[11/03/16]

Questions Surround CMS’s Announcement of Participation Options for MIPS and Advanced APMs for 2017

[09/14/16]

CMS Delays Implementation of NOTICE Act in Final Rule

[08/03/16]

MIPS and the Oncology Care Model

[07/29/16]

CMS Leaves Many Unanswered Questions in Proposed Rules for Off-Campus Provider-Based Exclusion

[07/08/16]

CMS to Consider Provider-Based Concerns with Budget Act Implementation

[04/06/16]

CMS Issues Final Overpayment Refund Rule

[02/12/16]

Reminder: New Billing Requirements for Off-Campus Provider-Based Departments Effective January 1, 2016

[12/21/15]

Provider-Based: The Visiting Specialist Solution to CMS’s Evolving Exclusive Use Standard

[11/24/15]

Budget Blast: Exclusion of Hospital Payment for “New” Off-Campus Hospital Departments

[11/03/15]

340B Program Omnibus Guidance: A Deeper Dive

[09/03/15]

340B Program House Subcommittee Testimony: Overview and Insights

[03/30/15]

New CMS Regulation Targets Billing Privileges

[12/11/14]

Medicare’s Shifting Landscape: New Labor Market Areas May Jeopardize Special Rural Status for Certain Hospitals and Create New Opportunities for Others

[08/08/14]

CMS Did Not Finalize Proposed Changes to Cost Reporting Requirements and PRRB Appeals

[08/06/14]

Privileged Compliance Investigations: A Strategy for Avoiding Retained Overpayment FCA Actions

[07/02/14]

CMS Proposes Changes to Cost Reporting and PRRB Appeal Regulations

[06/20/14]

Implications of the U.S. District Court Opinion Vacating the 340B Program’s “Orphan Drug” Final Rule and Regulations

[05/29/14]

DSH Medicaid Eligible Days Documentation

[05/28/14]

OIG Releases Report Recommending Reduction of OPPS Payment Rates to ASC Rates

[05/01/14]

Important DSH Decision by Court of Appeals

[04/10/14]

Urgent Reminder to Physician-Owned Hospitals: Action Required by March 1, 2014

[02/11/14]

MedPAC Recommends Decreasing Payments for Hospital Outpatient Services

[02/06/14]

Summary of the OIG 2014 Work Plan

[02/04/14]

2-Midnight Rule 0.2% IPPS Offset Group Appeal

[01/17/14]

CMS Publishes 2014 Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule

[12/09/13]

CMS Publishes 2014 Physician Fee Schedule Final Rule

[12/06/13]

CMS Delays Full Implementation of the 2-Midnight Rule Until January 1, 2014

[10/01/13]

CMS Issues Proposed Rule Establishing Medicare FQHC Prospective Payment System

[09/30/13]

OIG Recommendations Could Jeopardize Nearly Two-Thirds of CAHs’ Status

[08/15/13]

2014 IPPS Final Rule – CMS Clarifies Inpatient Admission Criteria to Reduce Payment Uncertainty

[08/14/13]

D.C. Circuit Upholds Medicare Overpayment Extrapolation Determination

[08/01/13]

HRSA Issues 340B Program Orphan Drug Final Rule and Regulations

[07/24/13]

Hall Render Detailed Check-Up: 2013 GME Update

[05/01/13]

HRSA Extends 340B GPO Exclusion Guidance Compliance Deadline from April 7, 2013 to August 7, 2013

[04/08/13]

OIG Report Shows Many Co-Located LTCHs Fail to Notify of Co-Located Status; LTCHs Face Potential Overpayment Risk

[03/07/13]

Allina Health DSH Case Implications: DSH Payments and 340B Eligibility

[02/14/13]

CMS Revises Its Policy Regarding Therapy Caps for Critical Access Hospitals

[02/06/13]

Time Equals Money: Recent Change to Medicare Overpayment Recovery Period

[01/24/13]

U.S. Supreme Court Eliminates Possibility of Using Equitable Tolling for PRRB Appeals

[01/22/13]

The American Taxpayer Relief Act of 2012: More Changes to Medicare Therapy Caps and Payments

[01/04/13]

Proposed Drug Shortage Bill Threatens 340B Drug Discounts for Injectables

[12/13/12]

CMS Publishes CY 2013 Home Health Prospective Payment System Final Rule

[12/13/12]

Second in Series on Medicare DSH Payment Issues

[09/19/12]

Medicare Therapy Caps: Changes Effective October 1, 2012 and the Impact on Hospital Outpatients and Others

[09/11/12]

CMS Publishes CY 2013 OPPS/ASC Proposed Rule – Summary of Key Provisions

[08/24/12]

HRSA Releases 340B Program Audit Guidance

[06/21/12]

CMS Proposes Changes to GME Rules in 2013 IPPS Proposed Rule

[05/29/12]

DSH Data Now Available – CMS Webinar May 8 on Data Use Agreement Requirements

[05/07/12]

First in Series on Medicare DSH and Top Cost Report Appeal Issues

[04/10/12]

What’s Going on with the CMS Self-Referral Disclosure Protocol? – Recent Developments

[04/06/12]

Rural Health Clinic Medicare Deeming Authority Approved

[03/27/12]

340B Update: HRSA Issues Program Notice Addressing Ongoing 340B Program Audits

[03/09/12]

CMS Issues Proposed Rule to Implement Statutory Obligation to Report and Return Overpayments

[02/17/12]

OIG Alert on Reassignment Raises Concern for Physicians

[02/09/12]

CMS Holds Open Door Forum for Part A to Part B Rebilling Demonstration Project

[11/30/11]

Medicare Changes to the 3-Day Payment Window Rule Impact Physician Billing in 2012

[11/08/11]

Possible Rural Health Clinic Deeming Authority on the Horizon – Comments Requested

[11/08/11]

Final Rule Implements State Requirements for Medicaid Recovery Audit Contractors

[10/14/11]

PRRB Rules in Favor of Hospitals on Two Wage Index Issues

[10/13/11]

CMS Changes Reporting Requirements for Pension Costs Includable in the Medicare Wage Index. Transition Policy Allows Positive Adjustment for Defined Benefit Pension Plans That Were Prefunded during FYs 2007 – 2012.

[09/22/11]

Medicare Changes to the 3-Day Window Rule

[08/10/11]

CMS Issues FFY 2012 IRF PPS Final Rule

[08/09/11]

CMS Issues FFY 2012 IPPS Final Rule

[08/02/11]

Ask Not For Whom The Equitable Bell Tolls

[07/29/11]

UPDATE: OIG Issues First Three Reports from Onsite Audits of Hospital Error Prone Billing Issues

[07/25/11]

Proposed Rule: Revised TRICARE Inpatient Payment Methodology for Sole Community Hospitals

[07/22/11]

CMS Final Rule to Adjust Medicaid Payment for Provider-Preventable Conditions Including Health Care-Acquired Conditions

[06/20/11]

Favorable Opinion Issued in Cape Cod v. Sebelius

[01/14/11]