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
The International Statistical Classification of Diseases and Related Health Problems, commonly known as the ICD, is a globally recognized system of medical data management. Developed, maintained, and copyrighted by the World Health Organization (WHO), the ICD offers a comprehensive framework for classifying diseases, medical conditions, and other health-related phenomena. Its tenth iteration is referred to [...] Read More
Federal Administrative Law Judges (ALJs) exercise considerable authority in our national healthcare system. ALJs in the Food and Drug Administration routinely make adjudicatory decisions regarding drugs and medical devices. Those working within the Department of Labor may render decisions impacting a healthcare provider’s workforce or workplace. And the determinations of ALJs within the Drug Enforcement [...] Read More
On June 22, 2023, Centers for Medicare & Medicaid Services (CMS) released the highly anticipated proposed Medicare device coverage pathway for breakthrough medical devices, known as Transitional Coverage for Emerging Technologies (CMS-3421). Rather than a newly proposed rule, CMS released a proposed notice, which describes the process CMS will use to provide transitional coverage for [...] Read More
On March 2 and 3, 2023, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting. The meeting included sessions on the following: Reforming Medicare’s wage index systems; Addressing the high prices of drugs covered under Medicare Part B; Mandated report: Evaluation of a prototype design for a post-acute care prospective payment system; Favorable [...] Read More
On November 1, the Centers for Medicare & Medicaid Services (CMS) issued the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule with Comment Period, which finalizes updates to the outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year (CY) 2023. See the press [...] Read More
On November 1, the Centers for Medicare & Medicaid Services (CMS) issued the final calendar year (CY) 2023 Physician Fee Schedule, which proposes policies for physician payment and other outpatient services covered under Medicare Part B. The official CMS press release is available here. CMS has provided a rule overview fact sheet and a Medicare [...] Read More