Tag: Outpatient Care Providers.


CMS System Edits Reduced Medicare Overpayments to Hospitals

Medicare overpayments totaled $39.3 million between September 2016 and December 2021, but most of those improper payments occurred before CMS corrected its system edits error in May 2019. CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the […]
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How Ambulatory Surgery Centers Lower Payer Outpatient Spending

Payers can reduce surgical costs by 59 percent by shifting eligible members from the hospital outpatient setting to ambulatory surgery centers. Ambulatory surgery centers are care sites that offer surgical procedures, diagnostics, and preventive care services, according to the Ambulatory Surgery Center Association. These sites are not provider offices, rural healthcare clinics, or urgent or […]
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Hospital Pros and Cons of the CY 2022 OPPS Proposed Rule

Hospital groups are digesting the 863-page CY 2022 OPPS proposed rule, but many are already commenting on new hospital price transparency penalties and other policies. The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other policies. The […]
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