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.

ReOpening America Guidelines – Phase 1 – April 19, 2020

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From the Centers for Medicare and Medicaid Services: The United States is experiencing an unprecedented public health emergency from the COVID-19 pandemic. Healthcare facilities in some areas are stretched to their limits of capacity, and surge areas have been needed to augment care for patients with COVID-19. To expand capacity to care for these patients […]

ICD-10

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On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and inpatient procedures were replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Click […]

IRF Data Files from CMS (2020 and 2019)

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FY2020 Final Rule Data Files Download for FY2020 (zip) includes: IRF Wage Index Final Rule – These files contain the proposed urban and rural Core-Based Statistical Area FY 2020 IRF wage index tables. IRF Rate Setting Final Rule – This file contains data for each of the 1,122 inpatient rehabilitation facilities used to estimate the policy updates in […]

Physician Fee Schedule and Quality Payment Program CY2020 Proposed Rule

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As part of CMS’s annual changes to the Medicare Physician Fee Schedule and Quality Payment Program, the agency’s proposals are aimed at reducing burden, recognizing clinicians for the time they spend with patients, removing unnecessary measures and making it easier for them to be on the path towards value-based care.  Last year, the Trump Administration finalized […]

Accountable Care Organizations under the Medicare Shared Savings Program

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December, 2018 Update: The national program for ACOs in Medicare has been in operation for six years, and over time CMS has learned from these experiences. Building on this experience, Pathways to Success overhauls the current program to put true accountability in Accountable Care Organizations and promote program-wide savings for Medicare’s ACOs. Pathways to Success […]

IPPS and LTCH Final Rule FY2019

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On August 2, 2018, CMS released the Final Rule for IPPS and LTCH for FY2019. Corrections were issued September 28, 2018. We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. […]

Medicaid Program Integrity Initiatives

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Today, the Centers for Medicare and Medicaid Services (CMS) announced new and enhanced initiatives designed to improve Medicaid program integrity through greater transparency and accountability, strengthened data, and innovative and robust analytic tools. Recent years have seen a rapid increase in Medicaid spending driven by several factors, including Medicaid expansion, from $456 billion in 2013 […]