On Demand Webinar | Intermediate | Payment, Reimbursement, and Managed Care

On December 21, CMS finalized the Medicare Shared Savings Program Pathways to Success rule. The final rule represents the most sweeping changes to the program since its inception. While accelerating the transition to risk, the rule's change...

On Demand Webinar | Intermediate | Payment, Reimbursement, and Managed Care

It's no secret how the rise in high deductible health plans and the self-pay population has impacted your bottom line. But can you connect improving a patient's experience to improving the financial health of your organization? During this ...

On Demand Webinar | Intermediate | Payment, Reimbursement, and Managed Care

This webinar reviews the Centers for Medicare and Medicaid Services (CMS) final inpatient prospective payment systems (IPPS) regulations. The final rule contains updated and changes affecting operations and capital-related costs for provide...

Fact Sheet | Payment, Reimbursement, and Managed Care

FY 2020 IPPS Proposed Rule Summary

Fact Sheet | Payment, Reimbursement, and Managed Care

FY 2020 IPPS Proposed Rule Summary

On April 23, 2019, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule describing federal fiscal year (FY) 2020 policies and rates for Medicare’s prospective payment systems for acute care inpatient hospitals (IPPS) and the long-term care hospital prospective payment system (LTCH PPS). The payment rates and policies described in the IPPS/LTCH proposed rule (CMS-1716-P) would affect Medicare’s operating and capital payments for short-term acute care hospital inpatient services and services provided in long-term care hospitals paid under their respective prospective payment systems. The proposed rule also sets forth rate-of-increase limits for inpatient services provided by certain “IPPS-Exempt” providers, such as cancer and children’s hospitals, and religious nonmedical health care institutions, which are paid based on reasonable costs. The proposed rule will be published in the Federal Register on May 3, 2019.

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How hospitals can create cost advantage where product differentiation is not present

Cost advantage can be achieved in two ways: Identifying whether efficient levels of cost exist and benchmarking.

Live Webinar | Legal and Regulatory Compliance

2020 Proposed Rule changes to Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Centers (ASC)

The ambulatory surgery center (ASC) payment system continues to evolve with the proposed changes to the hospital outpatient payment system (OPPS) for calendar year 2020. Find out what changes are proposed for implementation on January 1, 2020 for ASCs and hospital outpatient services in CY2019 final rule. Physician practice managers will want to keep a close watch on the ASC and OPPS developments as more services migrate from one setting to another. Prepare your organization now for the proposed changes.
Topics Include:

  • Proposed 2020 APC groupings
  • Proposed 2020 OPPS changes to drugs, biological, and radiopharmaceuticals
  • Proposed 2020 changes to OPPS for cancer hospitals and partial hospitalization services
  • Proposed 2020 changes to OPPS packaging
  • Proposed 2020 methods to control outpatient volume increases
  • Proposed 2020 changes to ASCs
  • Proposed 2020 changes to hospital outpatient quality requirements
  • Proposed 2020 additional changes to other policy areas

Column | Payment, Reimbursement, and Managed Care

Primary Care First Model holds promise but faces challenges

CMS's Primary Care First Model aims to create incentives for primary care physicians to take on risk under value-based payment, but whether it will be successful remains to be seen.

Article | Payment, Reimbursement, and Managed Care

What the numbers from PAC-improvement efforts show

Efforts to reduce spending on post-acute care have been shown to reduce variation in Medicare spending overall, while also reducing hospital readmissions.