The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS-1809-P), which includes proposals to update payment rates, policies and regul...
The Centers for Medicare & Medicaid Services (CMS) issued its2025 Physician Fee Schedule (PFS) proposed ruleearlier this month. Alongside a2.8 percent payment cutfor physicians, the rule includes numerous proposals directed at virtual care, including brand new codes for certain digital th...
CMS proposes an expansion of the regulations related to exclusion from the Medicare program. The proposed rule would allow CMS to revoke a provider’s or supplier’s Medicare enrollment if convicted of a federal or state misdemeanor within the previous 10 years. For exclusion to apply, CMS...
One of the troubling provisions in that Proposed Rule from a legal perspective was for drug manufacturers to “stack” cumulative price concessions provided to different entities to determine a final best price realized by the manufacturer. The proposed stacking provision...
rule. The CRA allows Congress to review and potentially invalidate new federal regulations by passing a joint resolution of disapproval. Given the forthcoming legislative and executive administration changes, there is an increased possibility that final rules, including thi...
2025. The proposed estimation methodology was intended to fulfill the IRA requirement to remove 340B units from rebate calculations for Part D inflation rebate calculations beginning on January 1, 2026. Instead, CMS notes in the Final Rule that it will explore est...
CMS for its part, has stated that the final rule will attempt to eliminate any duplicate reporting requirements. However, CMS also has advised that any information obtained will be posted on its website and available to the public. Comments or objections to the proposed rule are due by April...
products in the ESRD PPS bundled payment by January 1, 2025. CMS had previously excluded the products because of a lack of data. However, the agency is ready to operationalize the inclusion of the products in the ESRD Prospective Payment System moving forward, according to the proposed...
Top Take-Aways From CMS’ Proposed 2025 OPPS and PFS Rules and Final IPPS Rule 11 September 2024 Back to top Authors Judith A. Waltz Sectors Health Care & Life Sciences Providers of Health Care Services Practice Areas Health Care Location Webinar Agenda 2-3:30 p...
Implementation and broad provisions of the rule The rule, which is scheduled to be published in theFederal Registeron May 10, 2024, was finalized with only a few meaningful changes from the text that was proposed in September 2023. The rule will take effect onJune 21, 2024and ...