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CMS Finalizes its Proposal to Advance Interoperability and Improve Prior Authorization Processes

Healthcare Law Blog

Merit-based Incentive Payment System (“MIPS”) eligible clinicians, operating under the Promoting Interoperability performance category of MIPS, and eligible hospitals and critical access hospitals (“CAHs”), operating under the Medicare Promoting Interoperability Program, are impacted by the Final Rule, as well.

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Skilled Nursing Update: CMS Finalizes Changes to SNF Value-Based Purchasing, SNF Quality Reporting Program and Civil Monetary Penalties

Hall Render

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

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CMS Issues a New “Advancing Interoperability and Improving Prior Authorization Processes” Proposed Rule

C&M Health Law

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.

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Skilled Nursing Update: CMS Proposes Changes to SNF Value-Based Purchasing, SNF Quality Reporting Program and Civil Monetary Penalties

Hall Render

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024.

Nurses 40
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CMS Releases Final Rule: Transforming Episode Accountability Model

Hall Render

On August 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the Fiscal Year 2025 Hospital Inpatient Prospective Payment System Final Rule (“Final Rule”), finalizing the proposed Transforming Episode Accountability Model (“TEAM”). TEAM will begin on January 1, 2026.

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CMS prior authorization rule finally crosses the finish line

Redox

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.

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CMS Releases 2025 IPPS Final Rule

Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) will publish the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) in the Federal Register on August 28 with an effective date of October 1, 2024.