On the evening of October 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 final payment rule for home health agencies (HHAs). This rule includes the annual payment update for Home Health Agencies (HHAs) as well as policies for the Home Health Quality Reporting Program (HH QRP) and Home Health [...] Read More
On October 31, the Centers for Medicare & Medicaid Services (CMS) issued the 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule. The official CMS fact sheet is available here. In this final rule, CMS makes the following updates: Increases ESRD payment rates by 3.1 percent; Denies all three applications for transitional add-on [...] Read More
At Applied Policy, we assist many clients in understanding how Medicare reimburses for in vitro diagnostic (IVD) lab tests. Why do we focus on Medicare? Because Medicare payment policy decisions made by the Centers for Medicare & Medicaid Services (CMS) and its contractors are publicly available, rigorous, and often serve as the basis for private [...] Read More
The Medicare Advantage program (also known as Medicare Part C) has long been touted for its potential to lower costs, expand consumer choice, and improve health outcomes.[i] The popularity of Medicare Advantage (MA) plans has increased in the past decade with prospective enrollees enticed by benefits ranging from dental care to pest control and targeted [...] Read More
The Clinical Laboratory Improvement Amendments of 1988 and their associated regulations require laboratories performing moderate- or high-complexity testing to enroll in an approved proficiency-testing (PT) program “for each specialty, subspecialty, and analyte or test for which the laboratory is certified under CLIA.” These regulations were most-recently amended in 2012, and as of January 2017 there [...] Read More
The Department of Health and Human Services (HHS) has released a Draft Strategy titled “Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” As required by the 21st Century Cures Act, the draft strategy identifies an overall goal of reducing burden related to the use of EHRs and Health IT [...] Read More
Effective January 1, 2019, The Affordable Care Act has required each hospital to publish, update, and make public a list of its standard charges for items and services provided by each hospital; this includes diagnosis related groups (DRGs). In CMS’ 2019 Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) Rule and 2019 […]
Read MoreWith the release of the final 2019 Medicare Physician Fee Schedule (PFS) payment rule, CMS is touting program changes that aim to promote beneficiary access to virtual care and refine Medicare quality reporting requirements to emphasize reporting on measures linked to patient outcomes. Major initiatives are focused on: Proposed changes to the payment structure for [...] Read More
This evening, the Centers for Medicare and Medicaid Services (CMS) released the CY 2019 final payment rule for the End-Stage Renal Disease (ESRD) program. The rule contains a payment update for the ESRD Prospective Payment System, changes to the ESRD quality program, and an expansion of the ESRD Transitional Drug Add-on Payment Adjustment (TDAPA). Additionally, the [...] Read More
Today, the Centers for Medicare & Medicaid Services announced amendments to its Medicare Program Integrity Manual in accordance with the 21st Century Cures Act to modify the procedures by which Medicare Administrative Contractors (MACs) arrive at Local Coverage Determinations (LCDs). While any move in the direction of increased transparency is laudable, it remains to be seen [...] Read More