Medicare Payment and Reimbursement

CY 2024 Physician Fee Schedule Final Rule Summary – Part I

HFMA presents part I of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2024 and other revisions to Medicare Part B policies.

HFMA December 1, 2023

Congress doesn’t seem to be mulling a fix for the 2024 Medicare physician payment cut

Congress has mitigated a scheduled Medicare payment cut for physicians going into each of the last three years, but relief does not appear to be on the way for a fourth year running. Medicare’s 2024 final rule for physician payments includes a $1.15 decrease to the conversion factor, amounting to a reduction of more than…

Nick Hut November 27, 2023

Remedy for the 340B-Acquired Drug Payment Policy Final Rule Summary

HFMA presents a detailed summary of the final rule released by CMS describing its actions to craft a remedy relating to the adjustment of Medicare payment rates for drugs acquired under the 340B Program from calendar year 2018 through September 27, 2022.

HFMA November 20, 2023

Proposed rule sets Medicare penalties for providers that commit information-blocking infractions

Hospitals and other healthcare providers would face penalties for knowingly engaging in information blocking, with the sanctions affecting their Medicare reimbursement, according to a proposed rule from the U.S. Department of Health and Human Services (HHS) and CMS. Published at the beginning of November, the rule implements some terms of the 21st Century Cures Act,…

Nick Hut November 17, 2023

Senate bill would give hospitals a big break from looming Medicaid disproportionate share hospital cuts (updated)

Nov. 15 update: On Nov. 14, the House passed legislation on a bipartisan basis to keep the government funded through Jan. 19. Medicaid disproportionate share hospital payments would be guaranteed to remain at their full amount through that date, and the bill similarly maintains short-term funding for graduate medical education, community health centers and the…

Nick Hut November 13, 2023

CMS’s 340B-acquired drug payment policy final rule is here

The 340B Drug Pricing Program final rule was published[DF1] [SS2] [SS3]  in the Federal Register Nov. 8, 2023, after CMS released details of it (CMS-1793-F) on Nov. 2, 2023. The rule details the agency’s actions, and in some cases non-actions, to adjust Medicare payment rates for drugs acquired under the 340B program from calendar year 2018 through Sept.…

Shawn Stack November 8, 2023

Medicare’s hospital outpatient payment rate for 2024 improves marginally from the proposed rule

The final rule setting Medicare’s 2024 payment rates and policies for hospital outpatient services and ambulatory surgical centers (ASCs) contained no major surprises and little to make hospitals optimistic about the government portion of their payer mix. Here are five of the most important payment and coverage takeaways from the rule, which totals 1,672 pages…

Nick Hut November 7, 2023

Medicare’s final $9 billion remedy plan for 340B providers doesn’t address hospitals’ key concerns

Hospitals received final details on a $9 billion remedy payment plan for participants in the 340B Drug Pricing Program, with advocates expressing disappointment that corresponding reductions to other payments will go through as previously proposed. CMS issued a Nov. 2 final rule describing the terms of the remedy payment, which was necessitated after the Supreme…

Nick Hut November 3, 2023

HRSA curtails pandemic-era 340B flexibilities for hospitals’ off-campus outpatient facilities

In an expected move that stands to affect the savings reaped by health systems from the 340B Drug Pricing Program, the Health Resources and Services Administration (HRSA) is tightening participation requirements for off-campus outpatient facilities. In a published alert, HRSA announced plans to end pandemic-related flexibilities that have made it easier for off-campus outpatient facilities…

Nick Hut October 31, 2023

Healthcare News of Note: With new treatments emerging, Medicare increases coverage of PET screening for Alzheimer’s disease

Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. CMS updates Medicare coverage of PET scans as a screening tool for Alzheimer’s disease CMS recently moved to expand Medicare coverage of screening for a primary marker of Alzheimer’s disease, a key step…

Deborah Filipek October 26, 2023
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