On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”)released its Calendar Year (“CY”) 2022 Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center (“ASC”) Payment System final rule. This final rule is scheduled to be published in the Federal Register on November 16, 2021. In the final rule, CMS implements … Continue reading
The Centers for Medicare & Medicaid Services (“CMS”) has published the Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgery Center (“ASC”) final rule for CY 2021. CMS finalized an annual increase OPPS and ASC rates of 2.4 percent for CY 2021, based on a 2.4 percent market basket update and without a cut for … Continue reading
On Friday July 31, 2020 the U.S. Circuit Court of Appeals for the District of Columbia Circuit reversed the federal district court and permitted reimbursement cuts for drugs purchased through the 340B Drug Discount Program.… Continue reading
On November 15, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Changes Public final rule and the Transparency in Coverage proposed rule. CMS intends through this rulemaking to increase price transparency … Continue reading
On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) published its CY 2020 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. The final rule implements a number of significant changes to payment policies and rates for services furnished to Medicare beneficiaries in hospital outpatient … Continue reading
On October 21, 2019, U.S. District Judge Rosemary M. Collyer denied the government’s request to modify the Court’s previous ruling on September 17, 2019, that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it reduced Medicare payment rates for clinic visit evaluation and management (E&M) services provided to Medicare patients … Continue reading
On September 17, United States District Judge Rosemary M. Collyer, United States District Court for the District of Columbia, ruled that CMS in its CY 2019 OPPS final rule reducing Medicare payment rates for evaluation and management (E/M) services furnished to Medicare beneficiaries in hospital excepted off-campus hospital provider-based departments exceeded its statutory authority and … Continue reading
On July 29, the Centers for Medicare & Medicaid Services (CMS) published three proposed rules for Calendar Year (CY) 2020: Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule; Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule (MPFS); and End State Renal Disease … Continue reading
On July 25, 2018, the Centers for Medicare & Medicaid Services published its 2019 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule. A fact sheet describing the proposed rule is available here. The proposed rule can be accessed here. CMS proposes to update hospital OPPS payment rates … Continue reading
On November 2, 2017, the Centers for Medicare & Medicaid (CMS) Services issued its Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) final rule. The overall update to payments under the MPFS in 2018 will be +0.41 percent. The 2018 MPFS conversion factor will be $35.99, an increase from $35.89 in 2017. MPFS payment … Continue reading
On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its final hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule for Calendar Year (CY) 2018. On the same day CMS also issued its home health prospective payment system 2018 final rule. OPPS payment rates will … Continue reading
On December 13th, President Obama signed into law the 21st Century Cures Act. The legislation authorizes $4.8 billion for the National Institutes of Health to fund new initiatives in precision medicine, cancer, neuroscience, and regenerative medicine. The bill also provides $500 million over ten years for the Food and Drug Administration for the development of … Continue reading
On November 1, 2016, CMS issued its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period. CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) rates for certain items and services furnished by certain hospital off-campus outpatient departments. Significant provisions of the … Continue reading
On Tuesday, November 1, CMS published its Calendar Year 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period. The final rule includes provisions implementing the Bipartisan Budget Act of 2015, Section 603. On the same date CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) … Continue reading
On July 6, 2016, CMS published its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule. We provide a more detailed analysis of the significant proposals to our July 6 post below.… Continue reading
On November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015 (BBA 2015). BBA 2015, Section 603 generally provides that beginning January 1, 2017, off-campus hospital outpatient departments (HOPDs) will no longer be paid under the Medicare outpatient prospective payment system (OPPS) but rather under another applicable payment system, provided the … Continue reading
On November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015 (Act). Section 603 of the Act reduces Medicare payments to newly-enrolled provider-based, off-campus hospital outpatient departments (HOPDs), off-campus defined as a facility that is more than 250 yards from a hospital’s main buildings or a remote location of a hospital. … Continue reading
On October 30, 2015, CMS issued its calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (collectively, OPPS rule). In the final rule, CMS (1) updates payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs), ASCs and partial … Continue reading