Medisys Compliance

MARCH 14, 2023

In this article, we shared wound care reimbursements in certain healthcare facilities. Wound Care Reimbursements in Various Healthcare Settings Inpatient Hospital Wound care in an inpatient hospital setting is reimbursed through the Diagnosis-Related Group (DRG) payment system.

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Payment Systems Medical Billing Medicare Medicare 52

Hall Render

MARCH 4, 2025

SNF services covered by the Medicare Part A Skilled Nursing Prospective Payment System (PPS) payment are not designated health services (DHS) for purposes of the PSL. Hall Render blog posts and articles are intended for informational purposes only. 1395nn , is often referred to as the Stark Law.

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Medisys Compliance

APRIL 25, 2024

This article aims to simplify the impact of MACRA on your cardiology billing, empowering you to navigate these changes with confidence. MACRA replaced the previously used Sustainable Growth Rate (SGR) formula for Medicare physician payments. What is MACRA? Reporting accurate data for cardiology-specific quality measures is crucial.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Healthcare IT Today

AUGUST 13, 2023

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Practice management vendor Practice Better launched Practice Better Payments , a fully integrated payment system.

US Department of Health and Human Services 75

US Department of Health and Human Services Doctors Telemedicine Payment Systems 75

Hall Render

JULY 7, 2022

On June 30, 2022, the Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations (“Proposed Rule”) addressing the Conditions of Participation (“CoPs”) that a provider will need to meet to qualify as an REH. This facility payment will be adjusted each year by the annual hospital market basket update factor.

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Hospitals Payment Systems Medicare Medicare 70

Hall Render

SEPTEMBER 5, 2024

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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Hall Render

AUGUST 1, 2022

REHs may not operate swing beds but may maintain a distinct part skilled nursing facility, which will be paid under the skilled nursing facility prospective payment system. Proposed REH Payments. CMS ultimately proposed a monthly facility payment of $268,294 (just over $3.2 5 Percent OPPS Increase.

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Hospitals Payment Systems Medicare Medicare 40

YouCompli

FEBRUARY 22, 2023

Price increases can sometimes result in inappropriate outlier payments. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

AIHC

JANUARY 28, 2022

Medicare Uncompensated Care Payments & DSH Hospitals' charity care and bad debt, together known as uncompensated care, is used to calculate disproportionate-share hospital payments. LTCHs are paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS).

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Medicare Medicare Hospitals Payment Systems 40

Hall Render

NOVEMBER 6, 2024

CMS took regulatory action through the Calendar Year 2022 Home Health Prospective Payment System rule to extend those requirements through December 31, 2024. Hall Render blog posts and articles are intended for informational purposes only. Due to the nature of interim final rules, this requirement would have expired in May 2023.

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Nursing Homes Nurses Medicaid Medicaid 40

Hall Render

FEBRUARY 14, 2025

The Centers for Medicare & Medicaid Services (CMS) recently finalized a rule (Final Rule) that expands its ability to impose a Provisional Period of Enhanced Oversight (PPEO) on providers, including post-acute providers, reactivating their Medicare enrollment. See our previous article here. CMS finalized new 42 CFR Sec.

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Medicare Medicare Compliance Payment Systems 52

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay.

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Compliancy Group

JUNE 28, 2024

This article covers the disincentives that can be imposed on a provider found to have engaged in information blocking. HHS OIG determines whether a provider information blocking violation has occurred, and then notifies the Centers for Medicare and Medicaid Services (CMS) of its determination. CMS may then apply the disincentive.

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Medicare Medicare Hospitals HIPAA 59

Hall Render

MARCH 1, 2023

Following this reporting, impacted providers and teaching hospitals will have until May 15, 2023, to review reported payments and investments and to dispute any incorrect reports. During the Dispute Period, Covered Recipients may use CMS’ Open Payments system to formally dispute any information they believe is incorrect.

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Hospitals Payment Systems Nurses Medical Device Industry 40

Hall Render

NOVEMBER 14, 2024

Hall Render blog posts and articles are intended for informational purposes only. More information about Hall Render’s Post-Acute and Long-Term Care services can be found here. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.

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Payment Systems Medicare Medicare Medicaid 40

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3%

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Hospitals Medicare Medicare Medicaid 40

AIHC

NOVEMBER 15, 2022

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for enforcement and has been working with the American Hospital Association (AHA) to comply with challenges related to compliance. Just a few published press releases are cited below. Where Can We Obtain More Information to Comply?

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Hospitals US Department of Health and Human Services Compliance Governance 52

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. A special thanks to Julian Caruso, Summer Associate, for her assistance with this article.

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Payment Systems Hospitals Medicare Medicare 40

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Hall Render blog posts and articles are intended for informational purposes only.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

AUGUST 15, 2024

TempoPay, a health care financing and payments platform, was acquired by PayMedix. PayMedix is a health care financing and payment solutions provider owned by Health Payment Systems, a health care technology and services organization. Hall Render blog posts and articles are intended for informational purposes only.

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Payment Systems Medicaid Medicaid 40

Hall Render

AUGUST 15, 2024

TempoPay, a health care financing and payments platform, was acquired by PayMedix. PayMedix is a health care financing and payment solutions provider owned by Health Payment Systems, a health care technology and services organization. Hall Render blog posts and articles are intended for informational purposes only.

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Payment Systems Medicaid Medicaid 40

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.

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Medicare Medicare Health Insurance Medicaid 40

Hall Render

MAY 20, 2022

On May 10, 2022, CMS published its proposed revisions to the Inpatient Prospective Payment System for 2023. First, CMS proposed to update the way that it calculates direct GME (“DGME”) payments for fellows in some training programs, responding to the court’s decision in Milton S. Your primary Hall Render contact.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Hall Render

AUGUST 11, 2023

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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Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Hall Render

AUGUST 29, 2024

On August 28, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published the Fiscal Year 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”), which can be found here. Special thanks to Zachary Renier, Summer Associate, for his assistance in preparing this article.

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Hospitals Medicare Medicare Payment Systems 40

Hall Render

AUGUST 27, 2024

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. Hall Render blog posts and articles are intended for informational purposes only.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Hall Render

NOVEMBER 25, 2024

When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, the claim submission form includes certifications that the claimed services were provided in compliance with all applicable statutes, regulations and rules. Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

MAY 30, 2023

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

Nurses COVID-19 Vaccine COVID-19 Medicare 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.

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Medicare Medicare Hospitals Medicaid 40

Physician Credentialing Company

OCTOBER 25, 2024

In this article, we will discuss detailed information regarding what the 90834 CPT code means, who can assign it, and the services covered by it. Medicare and Medicaid may have different payment systems from those of the private health insurance plans.

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Licensing Medical Billing Telemedicine Medicare 52

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. Special thanks to summer associate, Liliann Stoll, for her assistance with this article.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

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.

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COVID-19 Payment Systems Medicare Medicare 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

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.

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