COVID-19 FAQs from CMS

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Recommendations for re-opening facilities for non-emergent non-COVID-19 healthcare CMS Press Releases on COVID-19 April 30, 2020 Update April 27, 2020 Update April 14, 2020 Update Open Payments Program FAQ (Apr 3, 2020) March 30, 2020 Update On March 6, 2020, the Centers for Medicare & Medicaid Services (CMS) issued frequently asked questions and answers (FAQs) […]

Modifier CR and DR during COVID-19

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Clarification on the DR (disaster related) and CR (catastrophe/disaster related) modifiers was issued by CMS on June 1, 2020 in this document.  The clarifications are the only changes made to this guidance.

IPPS and LTCH Proposed Rule FY2021

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On May 11, 2020, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that focuses the agency’s efforts on a singular objective: transforming the healthcare delivery system through competition and innovation to provide patients with better value and results. The proposed rule would update Medicare payment policies for hospitals under the Inpatient Prospective […]

COVID-19 New ICD-10-CM Code

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UPDATE: March 26, 2020 CMS has launched for information on COVID-19 Additional guidance may be found on the Current Emergencies page UPDATE: March 18, 2020 The CDC has announced that the effective date for this new code is April 1, 2020. Read the announcement here Responding to the public health emergency of the 2019 […]

NCCI Resources

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CMS originally developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. In 2008, CMS has been refining the edits based on 100% submitted claims data from a […]

OPPS Final Rule CY2020

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The policies in the final rule will further advance the agency’s commitment to increasing price transparency. It includes requirements that would apply to each hospital operating in the United States.  This final rule implements Section 2718(e) of the Public Health Service Act and improves upon prior agency guidance that required hospitals to make public their […]

Physician Fee Schedule 2020

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On November 1, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020. Payment Provisions: Ratesetting and conversion factor  CMS is finalizing a series of standard technical proposals involving practice expense, including […]

IRF-PAI Manual

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FY 2020 Information IRF-PAI (version 4.0 FINAL) – Effective October 1, 2020 (FY 2021), as proposed in the FY 2020 IRF PPS final rule. Change Table listing differences from the previous version IRF-PAI Manual Version 3.0 – This manual contains information regarding data collection on the IRF-PAI version 3.0, effective October 1, 2019. Please note that the IRF-PAI Manual […]

CMS Data Files for IRFs (2018 and prior)

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FY 2018 IRF PPS Final Rule Data Files (82 FR 36238) IRF Rate Setting Final Rule (82 FR 36238)  This file contains data for each of the 1,140 inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described […]