CMS and MedPAC Guidelines and Trends

MedPAC takes aim at the Medicare wage index and reiterates support for site-neutral payment

In its semiannual report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommends significant changes to two key aspects of Medicare policy: the wage index and site-neutral payment. 1. A revamp of the wage index The wage index consistently generates concern among healthcare stakeholders, including in Medicare’s FY24 proposed rule for hospital inpatient payments. According…

Nick Hut June 22, 2023

Medicare’s proposed FY24 update to inpatient payments falls short, hospitals say

Hospitals are less than pleased with Medicare’s proposed FY24 payment update for inpatient care. In proposed regulations, the net inpatient payment update is 2.8% after factoring in a mandatory productivity adjustment of -0.2 percentage points. As usual, the update would be reduced for any hospital that does not fulfill quality-reporting requirements or qualify as a…

Nick Hut April 12, 2023

Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers

Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.

Nick Hut January 18, 2023

TransUnion Medicare DSH solution helps hospitals identify reimbursement opportunities

Medicare disproportionate share hospital payments payments help serve low-income populations, but comes with a set of challenges such as identifying eligible patients. See one company’s solution by leveraging unique processing and data integration.

HFMA August 31, 2022

Utilization review staff may be hurting results when fixing incorrect inpatient admissions

There's a clear financial winner when choosing a method for correcting an incorrect inpatient admission.

Ronald Hirsch, MD June 9, 2022

The COVID-19 vaccine mandate for healthcare workers can take effect nationwide, Supreme Court says

The court lifted injunctions that had halted implementation of the COVID-19 vaccine mandate in half the country, leaving hospitals and other affected providers with likely only a few weeks to begin complying.

Nick Hut January 21, 2022

CMS proposes to restrict Medicare coverage of a high-profile new Alzheimer’s drug

Medicare will pay for use of a new drug to treat Alzheimer’s disease only for patients in approved clinical trials, CMS said in a proposed coverage determination.

Nick Hut January 12, 2022

CMS cancels regulations that would ensure coverage of breakthrough medical devices, but new legislation could fill the void

Citing patient safety concerns among other issues, CMS formally canceled a Trump administration rule that would have required Medicare to cover breakthrough medical devices.

Nick Hut November 20, 2021

The Medicare area wage index likely needs a revamp, MedPAC members say

Wage index adjustments leave some hospitals at a disadvantage and are costly for the Medicare program, according to policy advisers.

Nick Hut October 25, 2021

In 2022 OPPS rule, CMS plans to reinstate policies pertaining to the inpatient-only and ASC covered-procedures lists

The 2022 proposed rule for the Outpatient Prospective Payment System would reverse 2021 policies that began to phase out the inpatient-only list of procedures and expand the covered-procedures list for ambulatory surgical centers.

Nick Hut July 21, 2021
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