Reimbursement

CY 2025 Home Health Prospective Payment System Proposed Rule Summary

HFMA presents a detailed summary of the CY 2025 proposed rule updating payment rates for home health agencies.

HFMA August 7, 2024

Hospitals will get only a small bump in Medicare inpatient payments for FY25

Hospital representatives were less than excited about the rate update in Medicare’s FY25 final rule for inpatient care and long-term care hospitals. Published Aug. 1, the rule includes a 2.9% rate increase for acute care hospitals in the fiscal year that begins Oct. 1. The increase is derived from a 3.4% hike in the market…

Nick Hut August 2, 2024

Grace-Marie Turner: Medical innovation should not be stymied by misguided policy

The Inflation Reduction Act and the proposed march-in rights framework are threatening medical progress and innovation, leading to higher costs for seniors, fewer job opportunities, and a decrease in the number of new drugs brought to market.

Grace-Marie Turner July 31, 2024

Appeals court eliminates Medicare supplemental payments for low-wage hospitals (updated-2)

Note: This article was updated most recently Oct. 4 with news that CMS has ended the low-wage-index policy. See that update below. Plaintiff hospitals won litigation last week at the federal appellate level that will adversely affect Medicare payment for some rural hospitals. The U.S. Court of Appeals for the D.C. Circuit backed a district…

Nick Hut July 30, 2024

As providers seek resolution of continuing Change Healthcare issues, UnitedHealth Group reports strong financials

The aftermath of the Change Healthcare cyberattack affected the second-quarter financials of parent company UnitedHealth Group (UHG), but not to the point of hindering the company’s continued “diversified and durable growth,” CEO Andrew Witty said during a recent investor call. Q2 revenues increased by 6% year-over-year, while profits dropped by 5.5% amid costs stemming from…

Nick Hut July 26, 2024

CMS looks to fortify primary care with proposed new codes for advanced care management

With newly proposed regulations, CMS aims to establish coding and payment for services that promote longitudinal relationships between clinicians and patients in primary care. The provisions, part of Medicare’s 2025 proposed rule for physician payments, incorporate new HCPCS G-codes for advanced primary care management (APCM). Three bundles of APCM services would be billable as codes…

Nick Hut July 24, 2024

Medicare’s proposed 2025 rule for physician payments would add to the financial strain facing practices

Medicare’s proposed update to physician payments for 2025 left advocates saying practices will have an increasingly difficult time making ends meet. CMS’s newly proposed rule states that payments are set to be reduced by 2.8% from 2024, based on the change to the conversion factor. The agency explained that it is obligated to implement the…

Nick Hut July 18, 2024

A proposed Medicare condition of participation would bring a slew of new requirements for OB care

Note: HFMA’s coverage of the payment update in the outpatient payment proposed rule can be found here. Hospitals intending to participate in Medicare must meet new standards for obstetric (OB) care, according to CMS’s proposed outpatient rule for 2025. The rule proposes to establish a new Medicare condition of participation (CoP), whereby hospitals and critical…

Nick Hut July 12, 2024

Medicare’s proposed outpatient payment update for 2025 doesn’t keep pace with hospital costs, advocates say

Note: Additional coverage of the proposed rule can be found here. Hospital advocates expressed dissatisfaction with the payment update in Medicare’s 2025 proposed rule for hospital outpatient care and ambulatory surgical centers (ASCs). CMS proposes to increase the Medicare rate for outpatient services and ASCs by 2.6%, resulting from a 3% jump in the market…

Nick Hut July 11, 2024

CMS proposes to hold Medicare ACOs harmless for spending levels stemming from catheter-billing fraud

CMS has issued a proposed rule to mitigate the impact of a high-profile Medicare fraud scheme on accountable care organizations (ACOs). The rule seeks to address “significant, anomalous and highly suspect billing activity for selected intermittent urinary catheters on Medicare Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims” as applied to ACOs in the…

Nick Hut July 9, 2024
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