Under the inpatient prospective payment system (IPPS), firms that own new and expensive technologies can apply for these technologies to receive new technology add-on payments (NTAPs.) The NTAP program was created in 2001 after Congress, concerned that the existing IPPS reimbursement structure did not incentivize the use of new technologies, passed a law[1] requiring the [...] Read More
On April 10, 2024 the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System proposed rule. See the press release here. CMS released a fact sheet accompanying the rule. The rule proposes [...] Read More
On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies that would update program policies for Medicare Advantage and Medicare Part D beginning in 2025. CMS also issued its Final Calendar Year [...] Read More
The counterpart to Medicaid’s Disproportionate Share Hospital (DSH) program, Medicare’s DSH program was established with the shared objective of providing financial support to hospitals that serve a large number of low-income patients. Yet, despite this common purpose, the two programs differ significantly in terms of operational frameworks, eligibility criteria, and policy issues. Background The impetus [...] Read More
Each March, the Medicare Payment Advisory Commission (MedPAC) is required to report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). In this report, MedPAC provides payment update recommendations for Medicare FFS payment systems, status updates on ambulatory surgical centers (ASCs), [...] Read More
On March 7 and 8, 2024, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting, which included the following sessions: Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources; Preliminary analysis of Medicare Advantage quality; Rural hospital and clinical payment policy: A workplan for 2024-2025; [...] Read More
The Healthcare Common Procedure Coding System (HCPCS, pronounced “hix-pix”) maintained by the Centers for Medicare & Medicaid Services (CMS) comprises two medical code sets, HCPCS Level I and HCPCS Level II. Level I consists of the Current Procedural Terminology© (CPT), a classification index which, as Applied Policy has previously discussed, is developed, maintained, and copyrighted [...] Read More
On November 2, the Centers for Medicare & Medicaid Services (CMS) issued the final calendar year (CY) 2024 Physician Fee Schedule, which finalizes policies for physician payment and other outpatient services covered under Medicare Part B. CMS released a fact sheet and a press release in tandem with the final rule. CMS also published a [...] Read More
On November 1, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 final payment rule for home health agencies (HHAs). The final rule includes the annual payment update and changes to the home health quality reporting program and value-based purchasing model. The final rule also includes provisions on durable [...] Read More
On October 27, the Centers for Medicare & Medicaid Services (CMS) issued the End-Stage Renal Disease (ESRD) Prospective Payment System final rule for calendar year (CY) 2024. See the fact sheet here. This rule finalizes the following changes: Increases ESRD payment rates by 2.1 percent, Finalizes a new transitional add-on pediatric ESRD dialysis payment adjustment, [...] Read More