Tag: : CMS Updates

IDR resolution processing fees have been revamped

Updated IDR Processing Fees Post-No Surprises Act Lawsuit

As a result of the most recent provider lawsuit, IDR processing fees have been reworked. Since its inception on Jan. 1, 2022, the No Surprises Act (NSA) has had its growing pains, including four lawsuits challenging the process of Independent Dispute Resolution (IDR). Out-of-network services are paid for with this process when health plans, healthcare […]
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New-Appeal-Rights-for-Patients

CMS Announces New Appeal Rights

Appeal rights appear much narrower than many expected. Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class action lawsuit. Filed by a group of Medicare beneficiaries, the suit alleged they had to pay out of pocket for skilled nursing care—despite being hospitalized for over three days—because their […]
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Final-Rules-for-Hospice-Providers-IPFs-IRFs-for-FY23

FY23 Final Rules for Hospice Providers, IPFs, IRFs

The final rules for fiscal year 2023 include a 3.8 percent payment increase for hospice providers, 2.5 percent increase for inpatient psychiatric facilities, and 3.2 percent boost for inpatient rehabilitation facilities. CMS has released final rules solidifying Medicare reimbursement rates for hospice providers, inpatient psychiatric facilities (IPFs), and inpatient rehabilitation facilities (IRFs) for fiscal year […]
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Home-and-Community-Based-Care-Quality-measure-set

Quality Measure Set to Improve Home & Community-Based Care

The home- and community-based services quality measure set also aims to advance health equity and reduce health disparities for older adults and people with disabilities. CMS has released a quality measure set for home- and community-based services (HCBS), aiming to promote consistent quality measurement and data collection in the Medicaid HCBS program and improve health […]
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Mid-Year-Medicare-Expansion-Updates

5 Mid-Year Medicaid Expansion Updates

Of the 12 states that have not expanded their Medicaid programs, four have taken legal, legislative, and/or budgetary actions this year with varying results. The Kaiser Family Foundation (KFF) has updated its state Medicaid expansion tracker, highlighting 2022 activity through July. The following summarizes activity in both expansion and non-expansion states. In January 2022, Georgia […]
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Minimum-Staffing-Requirements-for-Nursing-Homes

Minimum Staffing Requirement for Nursing Homes

More than 200,000 residents could be at risk of displacement if federal leaders establish minimum staffing requirements for nursing homes. Nursing homes would have to spend up to $10 billion per year and hire almost 188,000 nurses to comply with increased minimum staffing requirements, according to a report from the American Health Care Association (AHCA) […]
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Policy-for-Rural-Emergency-Hospitals

CMS on establishing new policies for REH

It includes proposed enhanced payments for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators. The Centers for Medicare and Medicaid Services is proposing actions meant to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral […]
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Medicare-Physician-Fee-Schedule-2023

New Rule on Medicare Physician Fee Schedule for the CY 2023

In addition to physician reimbursement cuts, CMS included changes to the Quality Payment Program in the CY 2023 Medicare Physician Fee Schedule proposed rule. In its recently released calendar year (CY) 2023 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposed Quality Payment Program (QPP) changes to the Merit-based Incentive Payment System (MIPS) and Advanced […]
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