C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Redox

JANUARY 24, 2024

While most of the rule focuses on payer requirements, it also requires that Merit-Based Incentive Payment System (MIPS) “Promoting Interoperability Program” eligible providers report on their use of Prior Authorization APIs in a new “Electronic Prior Authorization” measure.

HIPAA 59

HIPAA Compliance Payment Systems 59

Medisys Compliance

APRIL 18, 2022

Beginning in 2026, QPs will receive a higher annual Medicare fee schedule adjustment than non-QPs. In addition, eligible clinicians who participate in certain APMs but don’t meet the QP requirements may still receive more favorable scoring under MIPS.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

Hall Render

MARCH 20, 2024

The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive Payment System.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

CMS.gov

OCTOBER 2, 2018

economy, and by 2026 the CMS Office of the Actuary projects that one in every five dollars spent in America will be spent on healthcare. As costs are increasing, we must make the healthcare system more efficient. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies.

Medicare 44

Medicare Medicare Payment Systems FDA 44

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). One of the largest changes to home health payment under PDGM was the move to variable LUPA thresholds.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment.

Medicare 52

Medicare Medicare Payment Systems COVID-19 52

CMS.gov

DECEMBER 21, 2018

CMS is hard at work to move to a value-based system, not just because we want to, but because the American healthcare system is on an unsustainable trajectory, with one in five dollars spent in our economy projected to be spent on healthcare by 2026.

Medicare 41

Medicare Medicare Payment Systems Fraud 41