A projected Medicare physician payment decrease spurs more calls to reform the system
Physician advocacy groups vehemently expressed concern about the financial consequences of CMS’s proposed rule for Medicare physician payments in 2024, intensifying a push to modify the payment system. At a time of elevated expenses in healthcare, total payments would be reduced by a projected 1.25% relative to 2023. That would follow a 2% decrease from…
Remedy for 340B-Acquired Drug Payment Policy Proposed Rule Summary
FMA presents a detailed summary of the proposed rule describing the Agency’s proposed actions to craft a remedy relating to the adjustment of Medicare payment rates for drugs acquired under the 340B Program from calendar 2018 through September 27, 2022.
House committee approves bill requiring national provider identifiers for off-campus outpatient departments
A bill with widespread support in Congress would affect hospital billing procedures at off-campus outpatient departments if it becomes law. The House Committee on Education and the Workforce on July 12 unanimously approved legislation called the Transparency in Billing Act, which states that starting in 2024, hospital claims for items and services furnished in off-campus…
Medicare outpatient payments to hospitals won’t rise considerably in 2024, according to a proposed rule
Medicare’s newly proposed outpatient payment update for 2024 is unlikely to be greeted with enthusiasm by hospitals. The update for items and services provided in the hospital outpatient or ambulatory surgical center setting would be 2.8%, mirroring the proposed change for inpatient payments. The base update would be 3%, with a statutorily required productivity adjustment…
Billions of dollars in lump-sum payments are coming to hospitals as a remedy for 340B-related underpayments
Hospitals that participate in the 340B Drug Pricing Program stand to receive $9 billion in aggregate lump-sum payments as compensation for underpayments from Medicare during a nearly five-year period. In a proposed rule issued July 7, CMS described how it would provide remedies following a 2022 Supreme Court ruling that the U.S. Department of Health…
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…
Medicare coverage and coding updates: New Alzheimer’s drugs to be covered, but not universally
Note: This article was updated July 6. For drugs manufactured to slow the progression of Alzheimer’s disease, Medicare will offer coverage with certain qualifications, according to a recent CMS announcement. The new policy especially is relevant because the FDA’s first full approval of an Alzheimer’s disease drug may be only a month or so away.…
Report quantifies the financial impact of certain health plan business practices on providers
As hospitals seek to regain their financial footing coming out of the pandemic, they may find themselves stymied by commercial payer policies, according to a new report. “It’s true that commercial payers might generate more net revenue than public payers on a per-case basis,” Crowe states in a report it recently published. “But at what…
The state of Medicare Advantage: As the program grows, healthcare stakeholders express concerns
As seen during a recent virtual conference, the accelerating expansion of Medicare Advantage (MA) has been accompanied by tension over growing pains such as regulatory issues. “I think MA was set up really well, but like anything else there’s sort of a moment where you have to look at the program and say: How do…
CMS issues RFI to gather best practices for identifying and supporting safety net hospitals
As part of the FY24 proposed rule for hospital inpatient payments, CMS is seeking healthcare stakeholder input on how to best support safety net hospitals in the Medicare program. The agency is considering ways to reimburse safety net hospitals via supplemental payments that may be better targeted than disproportionate share hospital (DSH) and uncompensated care…