CY2021 ESRD Proposed Rule

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On July 6, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2021. This rule also proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal […]

CY2021 Home Health Proposed Rule

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On Jun 25th CMS issued a proposed rule [CMS-1730-P] that proposes routine updates to the home health payment rates for calendar year (CY) 2021, in accordance with existing statutory and regulatory requirements. This proposed rule also includes a proposal to make permanent the regulatory changes related to telecommunications technologies in providing care under the Medicare […]

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 www.coronavirus.gov 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 […]