Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA) was intended to reduce Medicare spending on lab testing by implementing a market-based fee schedule and was prompted by the recognition that Medicare was paying higher rates for many tests than were private payers.[1] - Next phase in of up to 15 percent [...] Read More
On June 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released one of their two annual Reports to Congress.[1],[2] The report includes recommendations to revise Medicare Advantage (MA) benchmark policy, streamline the portfolio of alternative payment models (APMs), replace the existing skilled nursing facility value-based purchasing program, revise indirect medical education (IME) payments, and improve [...] Read More
On April 8th, 2021, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet and unpublished proposed rule, Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022, which updates payment rates and policies for these facilities: Increase [...] Read More
In late December 2020, the Trump Administration released a final rule designed to promote the use of value-based purchasing (VBP) arrangements between drug manufacturers and payers, including Medicaid. The final rule, released by the Centers for Medicare & Medicaid Services (CMS), also contains policies related to line extensions and copay accumulators. The incoming Biden Administration [...] Read More
On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) released its long-awaited Specialty Care Models to Improve Quality of Care and Reduce Expenditures final rule (link) and the Health Resources and Services Administration (HRSA) released its Removing Financial Disincentives to Living Organ Donation final rule (link) and updated guidelines (link). These rules [...] Read More
On the morning of August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System (OPPS) calendar year (CY) 2021 proposed rule. The rule also includes updates to the ambulatory surgical center (ASC) payment system and other specified policies: Update and refine the requirements for the Hospital Outpatient [...] Read More
On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final rule for inpatient rehabilitation facilities (IRFs) for fiscal year (FY) 2021. The rule finalizes provisions related to payment, documentation requirements, and use of non-physician practitioners. Provisions of this final rule are effective October 1, 2020. Inpatient Rehabilitation Facilities Will Get [...] Read More
On April 19, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for FY 2020 payment and quality program updates for skilled nursing facilities (SNFs). CMS estimates that Medicare payment to SNFs will increase by $887 million in FY 2020. The market basket update is to increase by 2.5 percent. SNFs [...] Read More