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CMS Finalizes FY 2021 Payment Policies for Hospitals, Adds New DRG for CAR-T Therapy, & Finalizes New Data Collection to Inform Future DRG Relative Weights

On the evening of September 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released its final rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates (link), which updates the FY 2021 payment systems for [...] Read More

CMS Releases Long-Awaited Proposed Physician Fee Schedule, Focus is on Telehealth, Extending COVID-19 Flexibilities

CMS has released the CY 2021 proposed Physician Fee Schedule (PFS). This proposed rule includes policies for payment to physicians as well as Medicare Part B policies. Comments on the proposed rule are due on October 5, 2020. CMS Likely to Finalize Medicare Physician Fee Schedule Provisions in December Typically, CMS releases its Medicare Physician [...] Read More

CMS Finalizes FY 2021 Payment Policies for SNFs, Hospices, Inpatient Psych Facilities

On the evening of July 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released three payment rules for the upcoming fiscal year 2021. These rules contain finalized payment policies for skilled nursing facilities (SNFs), hospices, and inpatient psychiatric facilities. Because of the ongoing COVID-19 public health emergency, CMS has limited the annual rulemaking [...] Read More

CMS Proposes FY 2021 Payment Policies for Hospitals; New DRG Proposed for CAR-T Therapies; CMS Seeks Data on Market-based Payment Rates

On the evening of May 11, 2020, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2021 proposed rule for inpatient hospitals and long-term care hospitals (LTCHs). The rule includes Medicare’s annual payment update as well as policies related to quality measurement, new technology add-on payments (NTAP), and CAR T-cell therapies. [...] Read More

CMS Announces Second Round of COVID-19 Flexibilities in Newly Released Regulation

On April 30th, the Centers for Medicare and Medicaid Services (CMS) announced a second interim final rule (IFC) aimed at addressing the ongoing COVID-19 public health emergency (PHE). The rule has not yet been submitted to the Federal Register. The rule include flexibilities for a variety of areas including infection control in long-term care facilities, [...] Read More

CMS Issues Additional Waivers & Interim Final Rule (CMS-5531-IFC) for COVID-19

On the afternoon of April 30th, the Centers for Medicare and Medicaid Services (CMS) announced that it submitted a second interim final rule (IFC) to the Federal Register and that it released an additional set of blanket waivers under section 1135 of the Social Security Act aimed at addressing the ongoing COVID-19 public health emergency (PHE). Below are many of the new flexibilities and capabilities included in the waivers and rule: Interim Final [...] Read More

Medicare Trustees’ Annual Report Predicts Same Depletion Date for Hospital Trust Fund, But Report Does Not Account for COVID-19 Pandemic

On April 22, 2020, the Medicare trustees released their annual report on the status of the two separate trust funds, the Hospital Insurance (HI) Trust Fund and the Supplementary Insurance (SMI) Trust Fund. The Board reports annually on the financial operation and actuarial status of the program in a combined report that covers Medicare Part [...] Read More

CMS Estimates Payment Increase for IRFs in FY 2021 and Proposes Expanded Role for Non-Physician Practitioners

On April 16, 2020, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for inpatient rehabilitation facilities (IRFs) for fiscal year (FY) 2021. The rule includes proposals related to payment, documentation requirements, and use of non-physician practitioners. Comments on the proposed rule are due on June 15, 2020. Payments to Inpatient Rehabilitation [...] Read More

CMS Releases Final Physician Payment Rule for 2020, Changes Made to E/M Coding and Care Management

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final calendar year (CY) 2020 Physician Fee Schedule (PFS). The rule includes the annual payment update for physicians in the Medicare program and also includes policies for the Quality Payment Program, care management services, and Opioid Treatment Program (OTPs). Provisions of [...] Read More

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