CMS final rule for inpatient payment services less draconian than expected; transplant centers urged to be cautious
OnApril 17, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released the U.S. Department of Health and Human Services (“HHS”) Notice of Benefit and Payment Parameters for 2024 Final Rule (the “Notice”) that includes standards for issuers and Marketplaces, and requirements f...
The Centers for Medicare & Medicaid Services (CMS) published aFinal Ruleon April 4, 2024, that makes a number of changes to regulations governing the Programs of All-Inclusive Care for the Elderly (PACE). Among other things, the Final Rule gives CMS additional grounds on which to deny PACE ...
The CMS final rule creates requirements for certain payers to streamline the prior authorization process. The rule also complements the Medicare Advantage requirements finalized in the Contract Year (CY) 2024 MA and Part D final rule, which add continuity of care requirements and reduce...
1, 2024. The Centers for Medicare & Medicaid Services (CMS) finalized its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment rates on Nov. 2 for calendar year (CY) 2024. The Final Rule will be effective on Jan. 1, 2024. The Final Rule ...
(OPPS)/Ambulatory Surgery Center (ASC) Payment System final rule (OPPS Final Rule),1in which the agency finalized several of the policies it proposed in the 2022 OPPS/ASC Payment System proposed rule (OPPS Proposed Rule).2In summary, in the OPPS Final Ru...
CMS has finalized policies to increase access to marketplace coverage and expand essential health benefits (EHBs) in the HHS 2025 Notice of Benefit and Payment Parameters final rule.
Subscribe Key takeaways A recent final rule outlines new rules for prior authorization and interoperability requirements impacting Medicare Advantage, Medicaid, CHIP, and Qualified Health Plans Beginning in 2026, payors will have to comply with time limit requirements on responses to prior authorizatio...
While these procedures are not related to orthopedic practice, it is important to remain cognizant of changes to the ASC CPL on an ongoing basis, particularly as many of the procedures CMS has sought to incentivize in the outpatient setting are orthopedic procedur...
In the final rule, CMS didn’t address specific comments related to the above but did state they would take all comments into consideration for future development of payment policies. IRF Transfer Policy The Office of Inspector General’s recommendation resulted in a proposed rule that solicited co...