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.

Payment Systems 52

Payment Systems Medical Billing Medicare Medicare 52

AIHC

JANUARY 28, 2022

For more information on filing compliance cost reports, attend the Medicare Cost Report Camp in March 2022 presented by KraftCPAs and sponsored by the American Institute of Healthcare Compliance. billion in uncompensated care payments for FY 2021, a decrease of approximately $60 million from FY 2020.

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Medicare Medicare Hospitals Payment Systems 40

Healthcare IT Today

NOVEMBER 12, 2023

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Health Payment Systems selected Madaket Health to manage its provider directory and roster requirements for No Surprises Act compliance.

Public Health 97

Public Health Payment Systems Medicare Medicare 97

Medisys Compliance

APRIL 25, 2024

Introduction The ever-evolving world of healthcare billing can feel complex, and with the introduction of MACRA (Medicare Access and CHIP Reauthorization Act) in 2015, cardiology practices have faced some adjustments. MACRA replaced the previously used Sustainable Growth Rate (SGR) formula for Medicare physician payments.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Medisys Compliance

FEBRUARY 16, 2025

This article explores the key aspects of Value-Based Care in Medical Billing, the challenges providers face, how reimbursement models are evolving, and strategies to optimize billing under the VBC framework. Quality Reporting Requirements: Participation in VBC programs often mandates rigorous quality reporting.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Patient Satisfaction Payment Systems 59

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. Standards for benchmarking and data completeness for the Medicare CQM collection type will mirror the MIPS benchmarking and scoring policies.

Medicare 40

Medicare Medicare Nurses Payment Systems 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. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

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. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

JULY 7, 2022

The Consolidated Appropriations Act, 2021 (the “Act”) signed into law on December 27, 2020, created a new Medicare provider type called a Rural Emergency Hospital (“REH”). The Proposed Rule did not contain the details of the payment policies for REHs, which CMS will develop in separate notice and comment rulemaking.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

Healthcare IT Today

SEPTEMBER 19, 2024

The following is a guest article by Aaron Timm, EVP and Chief Commercial Officer at Vivalink In recent years, Hospital-at-Home (HaH) programs have been accepted more widely as a way of providing acute-level care to patients at home. with its introduction of the Acute Hospital Care at Home (AHCAH) waiver in 2020. In the U.S.,

Hospitals 99

Hospitals Governance Telemedicine Payment Systems 99

Electronic Health Reporter

JANUARY 15, 2019

The article The 340B Drug Pricing Program: A Federal Court Enters the Fray appeared first on electronichealthreporter.com.

Medicaid 107

Medicaid Medicaid Payment Systems Medicare 107

Healthcare IT Today

NOVEMBER 29, 2023

The following is a guest article by Nathan Shepard, SVP of Product at Azalea Health As rural providers look to replace legacy solutions, they’re confronted with several critical decision points. It can also reduce the number of days in accounts receivable for health systems.

Payment Systems 126

Payment Systems Hospitals Medicare Medicare 126

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.

Medicare 52

Medicare Medicare Compliance Payment Systems 52

Jane Sarashon

FEBRUARY 29, 2024

As the authors of the HaH article assert, “at a societal level, HaH could help avoid billions in capital costs to build more brick-and-mortar hospitals,” I return to Roemer’s Law learned in graduate school that, in a volume-based payment system, “A built bed is a filled bed is a billed bed.”

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Hospitals COVID-19 Payment Systems HIPAA 110

YouCompli

FEBRUARY 22, 2023

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). For Medicare, this typically includes IPPS and OPPS.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

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.

Medicare 59

Medicare Medicare Hospitals HIPAA 59

Hall Render

AUGUST 1, 2022

The proposed payment policies include an initial monthly facility fee of approximately $268,000 per month, which will adjust in future years based on a market-basket update. REHs would also get a 5 percent add-on to most outpatient payments. Proposed REH Payments. 5 Percent OPPS Increase. million per year) for 2023.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Healthcare IT Today

JUNE 29, 2023

The following is a guest article by Isaac Smith, Billing, Coding, and Reimbursement Specialist at Medcare MSO ASCs are types of medical facilities that are subject to stringent regulations. Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid.

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Compliance Medicare Medicare Medical Billing 52

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. healthcare system were exorbitant.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Hall Render

APRIL 4, 2024

The Requestor’s services further include offering physician practices training related to the Medicare Merit-Based Incentive Payment System (“MIPS”), which could result in higher Medicare reimbursement to the Requestor’s clients. Hall Render blog posts and articles are intended for informational purposes only.

Payment Systems 40

Payment Systems Medicare Medicare Fraud 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”). Background Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

AUGUST 10, 2023

In doing so, CMS will finalize changes to its rural floor wage index policy that can drastically change payments for certain hospitals and its extension of the wage index add-on for low-wage hospitals. CMS also uses the hospital wage index for the Outpatient Prospective Payment System. percentage points.

Payment Systems 40

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. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. healthcare system were exorbitant.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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

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. One notable difference, however, is that the entity must enroll in Medicare as an REH. Background.

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Payment Systems Hospitals Medicare Medicare 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.

Hospitals 40

Hospitals Medicare Medicare 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.

Nursing Homes 40

Nursing Homes Nurses Medicaid Medicaid 40

Hall Render

APRIL 20, 2022

The release of the Proposed Rule and the accompanying tables also triggers the start to several deadlines for hospitals, including the unofficial start of the Medicare Geographic Classification Review Board (“MGCRB”) application process. The Medicare program also has an “in between” status called “Lugar status.” Background.

Medicare 40

Medicare Medicare Hospitals Payment Systems 40

Hall Render

APRIL 18, 2023

Background The Medicare Hospital Inpatient Prospective Payment System (“IPPS”) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment.

Medicare 40

Medicare Medicare Hospitals Payment Systems 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

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 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

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. If the non-compliance is still not resolved, hospitals will face a civil monetary penalty (CMP).

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Hospitals US Department of Health and Human Services Compliance Governance 52

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%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

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

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