CMS today issued this Final Rule (with comment period). SUMMARY: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of […]
CMS announced an 18-month pilot program to reduce medical record review for certain physicians while continuing to protect program integrity. Under the program, providers practicing within certain Advanced Alternative Payment Models (Advanced APMs) will be relieved of additional scrutiny under certain Medicare medical review programs. CMS has a statutory duty to protect the Medicare Trust […]
CMS issued a final rule to update fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, applies for discharges occurring on or […]
CMS announced an extension and statewide expansion of fraud-fighting temporary provider enrollment moratoria efforts in six states, along with a new related demonstration project to allow for certain exceptions to the moratoria and heightened screening requirements for new providers. CMS also announced it is immediately lifting the current temporary moratoria on all Medicare Part B, […]
This Final Rule revises and updates payment rates, quality measures and reporting requirements. It includes explanations of the methods used to make these changes. Read the IRF PPS Final Rule in the Federal Register for August 5, 2016 Data Files are available on this page at CMS.gov
CMS issued a proposed rule on April 21 outlining proposed fiscal year (FY) 2017 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2017 proposals are summarized below. Proposed Updates to IRF payment rates: Updates to the payment rates under […]
New Affordable Care Act initiative, designed to improve quality and cost, gives doctors and patients more control over health care delivery The Centers for Medicare & Medicaid Services (CMS) announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) […]
In conjunction with the President’s visit to the National Rx Drug Abuse and Heroin Summit, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to strengthen access to mental health and substance use services for people with Medicaid or Children’s Health Insurance Program (CHIP) coverage, aligning with protections already required of private health […]
New payment model test for nursing facility care aims to reduce avoidable hospitalizations The Centers for Medicare & Medicaid Services (CMS) announced it will test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing […]