A proposed 3.3% cut to physician pay would threaten access to care and efforts to bring more clinical oversight into nursing homes, advocacy groups are warning. A 2024 draft pay…
Medicare improperly paid practitioners at a higher non-facility rate for services provided to skilled nursing facility (SNF) or hospital inpatients, leading to over $22 million in over-payments, a report from…
Hierarchical Condition Categories (HCCs) and value-based care have been a major focus for healthcare organizations during recent years. As many of you may know, the Centers for Medicare & Medicaid…
Months of high-level discussions regarding reforming Medicare physician payment has culminated in physician lawmakers introducing bipartisan legislation advancing the first leg of the AMA’s three-part strategy for fixing the broken…
The American College of Rheumatology (ACR) commended CMS for its proposed prior authorization policies but asked the agency to expand its guidance to other utilization management tools and shorten the…
Following a recent US District Court ruling on the federal government’s arbitration process for disputed medical billing—making the protocol for issuing decisions on disputed claims unclear—CMS posted some clarifying guidance…
CMS proposes new rules for 2024 that apply to Medicare Advantage Plans. Last month, I told you that there would be big news coming, and sure enough, there was. The…
The anticipated issue date for the new audit is the 2024 fiscal year. Citing “consistently high error rates,” federal officials announced this week that they will be conducting a nationwide…
The final rules become effective Jan. 1, 2023. Amid this election season, the Centers for Medicare & Medicaid Services (CMS) has published final rules for the 2023 Part B Physician…
The Centers for Medicare and Medicaid Services has released the 2023 premiums, deductibles, and coinsurance amounts for fee-for-service Medicare Part A and Part B, and the 2023 Medicare Part D…
CMS has specific guidelines when defining “incident to” and shared visits. Recently, I was working with a client to help them understand “incident to” billing. We were discussing a situation…
Doctors can use a government database to compare their practice patterns to others across the nation, says a former Wall Street trader turned physician. The database, maintained by the Centers…
There are no new MS-DRGs in the Final Rule. The fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) Final Rule, released by the Centers for Medicare & Medicaid Services…
The proposed rule includes expansions to the Physician Payment Schedule as well as a focus on access to high-quality care. The Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule,…
June 30, 2022 William N. Parham, III, DirectorPaperwork Reduction StaffOffice of Strategic Operations and Regulatory AffairsCenters for Medicare & Medicaid Services7500 Security BoulevardBaltimore, Maryland 21244 Re: Provider Complaints Submission Process…
New codes and guidelines become effective Oct. 1, 2023. The Centers for Medicare & Medicaid Services (CMS) published the ICD-10-PCS codes and guidelines for the 2023 fiscal year on May…