While reviews by CMS could in theory include acceptances or even reductions in the amount proposed by submitters as counterlowers, those who submit WCMSA’s have come to know that CMS reviews of WCMSA’s most often come back in the form of a counterhigher. It is important to distinguish ...
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CMS will exempt some off-campus PBDs of rural SCHs from this volume-control measure because service volume at these sites is likely driven by factors outside of the increase in payment due to share of cost. CMS finalized that an excepted off-campus PBD of rural SCH would st...
On 21st October 2024, the National Medical Products Administration (“NMPA”) issued the Pilot Program for Segmented Production of Biological Products (“Pilot Program”) with immediate effect.Segmented production of biological products is a manufacturing approach where the production process of biological...
(LIS) benefit will now be eligible for the full LIS benefit in CY 2025. Lastly, parameters for maximum or minimum beneficiary cost-sharing in the coverage gap or above the annual out-of-pocket threshold did not need to be updated for CY 2025, as the coverage gap phase and beneficia...
CMS changed its position on residents that may be counted when determining the number of direct graduate medical education (DGME) and indirect graduate medical education (IME) full time equivalent (FTE) resident cap slots (GME cap slots) a closing hospital or program may temporarily...
A specified percentage of average non-FAMP — i.e., a specified percentage of the average non-FAMP across the four quarters of calendar year 2021 (or across the first full calendar year after market entry, as applicable), subject to an inflationary adjustment. The specified percentage will var...
Providers and suppliers can continue to submit Medicare claims as usual after receiving an accelerated/advance payment. For the first 120 days after receipt of an accelerated/advance payment, the provider/supplier will receive full payments for their claims. At the end of the 120-day period, the...
The Board affirmed the Intermediary’s adjustments. It found the Provider was not entitled to include the full-time equivalent (FTE) residents of another hospital in its base year count for the following reasons: (1) the Provider was not affiliated with the other hospital via an affiliation agr...
condition nomination and a potential vote on whether to move it forward to full evidence-based review, which, depending on the strength of the evidence, could lead to a future recommendation to add the condition to the RUSP. March 7, 2023:The Substance Abuse and Mental Health Services Administ...