Tag: Medicare Payment Rates


Anticipated Decrease in Medicare Reimbursement for Physicians in 2024

The Final Decrease Is Influenced By Add-On Codes and Regulatory Obligations On November 16th, the Centers for Medicare & Medicaid Services (CMS) released the finalized rule for the 2024 Medicare Physician Fee Schedule (MPFS) in the Federal Register. While the policies exhibit several positives, especially in primary care, telehealth, and behavioral healthcare, CMS remains dedicated […]
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CMS Announces Proposed Medicare Payment Reduction of 3.4%

The 2024 Medicare Physician Fee Schedule proposal includes a reduction of 3.4% to the conversion factor that determines Medicare payment rates. This reduction will widen the gap between practice expenses and reimbursement. If the proposal is approved, the new conversion rate will be $32.7476. Here are some other key highlights of the CMS proposal: The […]
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The 2022 OPPS/ASC Final Rule Finalizes 2% Boost in Payment Rates

CMS dramatically increases financial penalties for noncompliance with hospital price transparency rules. On Nov. 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, finalizing payment rates and policy changes affecting Medicare services furnished […]
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Health Policy Experts Offer 3 Fixes for Medicare’s ‘Dysfunctional’ Advanced-Imaging Payment System

Medicare’s approach to advanced imaging reimbursement has been “dysfunctional” for decades, but health policy experts have a few suggestions to fix it. Over the past 20 years, the federal payment program witnessed “substantial” increases in the performance of MRIs, CT scans and nuclear studies, mostly in doc offices. A shift later occurred to hospital outpatient […]
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Physicians Call for Fair Reimbursement for COVID-19 Vaccines

Physicians are asking for adequate reimbursement for all COVID-19 vaccines and their administration, according to a new policy statement from the American College of Physicians (ACP). The statement released on Jan. 12 calls on health policymakers to require insurers to “provide adequate reimbursement for all vaccines, including COVID-19 vaccines, administered according to” scientific guidelines established by the […]
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Congress Provides Relief on Medicare Payment; Passes Surprise Billing

The $1.4 trillion omnibus legislative package passed by Congress late Monday includes COVID-19 related relief for physicians, imposes new restrictions on surprise billing, and funds the government through fiscal 2021, which ends Sept. 30. The legislation mitigates budget neutrality cuts that would have slashed physician Medicare payment rates by 10.2% and extends the moratorium on the budget […]
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CMS Releases HCPCS Codes For Covid-19 Antibody Drug

A version of this article was first published December 14, 2020, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. CMS recently released two new HCPCS Level II codes for Regeneron’s antibody drugs casirivimab and imdevimab, effective for dates of service on or after November 21. The creation of the new codes comes in […]
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2021 Medicare Physician Payment Schedule

Final 2021 Medicare Pay Schedule: What Physicians Need to Know

The 2021 Medicare physician payment schedule finalized an AMA-developed approach for less burdensome coding and documenting of office and outpatient evaluation and management (E/M) services. The Centers for Medicare & Medicaid Services (CMS) also extended Medicare payment for many services delivered via telehealth at least until the end of calendar year 2021, but indicated that […]
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