Miscellaneous resources for clients and partners, including payment rule release updates, relevant agency news, legislative activities and other items of interest.
September 10, 2018
FDA Commissioner Scott Gottlieb, M.D. recently announced in a blog post that the FDA, building on its experience with joint parallel review process with CMS, has expanded its “Private Payer Program.”
March 23, 2016
The two-part model would change the current statutory rate for provider payment and add value-based purchasing incentives. Various industry groups, physician and patient organizations, and members of Congress have expressed concern about potential risks to Medicare beneficiaries. Comments are due to CMS by May 9, 2016.
March 09, 2016
On March 8th, the Centers for Medicare & Medicaid Services posted a Notice of Proposed Rulemaking to test a new model for the payment of physician administered drugs under the Part B program, including drugs paid separately under the Outpatient Prospective Payment System (OPPS).
September 16, 2015
After years of delay, next month the US health care system will soon be replacing the ICD-9 code set with ICD-10 on October 1, 2015. In recent weeks CMS has made a series of announcements, primarily targeted at the physician community, to assist them during this final stretch in the transition to ICD-10.
September 14, 2015
Summary and analysis of issues discussed during Day 2 of the September MedPAC meeting, including Medicare’s ability to negotiate drug prices and expanding the Open Payments program.
June 30, 2015
On June 30, 2015 CMS published 2014 Open Payments data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.
June 22, 2015
The Senate Finance Committee today announced a mark-up on June 24th where the Committee will consider 12 healthcare related measures that would affect hospitals, post-acute care providers and ambulatory surgery centers, among others.
April 29, 2015
Progress continues with the 21st Century Cures Initiative as bipartisan leaders of House Energy and Commerce Committee released a discussion draft today which builds on the hearings and issue papers from the past year as well as the 21st Century Cures Initiative discussion document released in January 2015.
April 15, 2015
With draconian 21% cuts to physician payments looming, the Senate took action late yesterday; approving H.R. 2 by an overwhelming majority (98-2), and permanently repealing the much-maligned Sustainable Growth Rate (SGR).
March 27, 2015
The Centers for Medicare and Medicaid Services (CMS) has announced that physician payments will not be cut on April 1, notwithstanding the Senate’s failure to approve the Sustainable Growth Rate (SGR) legislation before its two week recess.
March 02, 2015
The U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) will hold a full committee hearing on Tuesday, March 10, 2015 at 10:00 AM focusing on continuing America’s leadership in medical innovation for patients.
January 27, 2015
House Energy and Commerce Committee releases discussion document outlining proposals shared through the 21st Century Cures initiative in order to encourage continued participation from patients, care givers, researchers and other experts.
January 26, 2015
Today the U.S. Department of Health and Human Services (HHS) unveiled its “Better. Smarter. Healthier.” initiative. In it, the HHS released a timeline moving Medicare away from fee-for-service reimbursement to value models, placing a premium on the quality, rather than quantity, of service provided to patients.
January 23, 2015
Providers that participate in the 2014 Physician Quality Reporting System (PQRS) program can earn a bonus payment for 2014 and avoid a penalty in 2016. Although the claims-based reporting option is no longer available, providers can still choose from several electronic submission options.
January 05, 2015
In 2013, CMS announced that the jurisdictions of the RACs would be changed. In January 2014, CMS announced its plans to contract with four regional RACs responsible for the review of Part A and Part B claims and a single national RAC responsible for review of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DME) and Home Health and Hospice (HH&H) claims.
December 12, 2014
The Centers for Medicare and Medicaid Services (CMS) have released a bidding timeline for the Round 2 Recompete and the national mail-order recompete for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program.
December 12, 2014
The Centers for Medicare and Medicaid Services (CMS) has proposed a new rule in today’s Federal Register revising the Medicare conditions of participation for hospitals and long-term care hospitals to provide that same-sex spouses in legally valid marriages are recognized and afforded equal rights in the Medicare and Medicaid participating facilities.
December 10, 2014
The House Energy and Commerce Committee has released a new 21st Century Cures initiative white paper seeking comments on the regulation of in vitro diagnostic test kits and laboratory developed tests.
December 05, 2014
The Centers for Medicare and Medicaid (CMS) will host a town hall meeting on February 3, 2015 in order to discuss applications for add-on payments for new medical services and technology under the hospital inpatient prospective payment system (IPPS).
December 03, 2014
On December 2nd the U.S. House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced the Protecting the Integrity of Medicare Act (PIMA) of 2014.
November 17, 2014
On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) released its annual final rule (Final Rule) setting the payment rates and coverage policies for items and services reimbursed under the Outpatient Prospective Payment System in Calendar Year 2015. Within the Final Rule, CMS confirmed several important changes for skin substitutes, including how established products…
November 01, 2014
On October 31, 2014, CMS issued the CY 2015 Final Rule for the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. This release includes policy changes and payment rates (including rates for new codes) are effective as of January 1, 2015.
October 13, 2014
Preliminary determinations include delay of decision-making on new codes describing drug testing, continuation of “gap-filling” for Multi-Analyte Assays with Algorithmic Analysis and Molecular Pathology codes, and a preliminary pricing decision for a new colorectal cancer screening test. CMS will accept comments until November 8, 2014.
August 07, 2014
On July 31, the U.S. Food and Drug Administration (FDA) released a notice to Congress announcing the agency’s intent to release a draft guidance providing a framework for bringing laboratory-developed tests under FDA’s regulatory authority.
August 06, 2014
In response to challenges veterans have experienced at Veterans Affairs (VA) health care facilities, the Veterans Access, Choice and Accountability Act allows veterans to receive care from non-VA providers in certain circumstances. All health care providers participating in Medicare have an opportunity to contract with the VA to provide care to the veterans population.
July 28, 2014
On July 22, 2014, the U.S. Department of Health and Human Services Office of Inspector General released a report critical of manufacturers’ Average Sales Price data reporting accuracy and equally critical of the Centers for Medicare & Medicaid Services’ ability to effectively collect such data and calculate national payment limits.
July 03, 2014
On July 3, 2014, CMS issued the federal CY 2015 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center Payment System Proposed Rules. These releases include policy changes and payment rates that would be effective as of January 1, 2015.
June 02, 2014
Earlier today, CMS has released the list of what hospitals charged for the most common inpatient procedures billed in 2012. This latest dataset builds upon the 2011 inpatient procedures data that was released last year and on the heels of the significant provider utilization data that became available in April 2014.
May 05, 2014
On April 30, 2014, CMS issued the federal FY 2015 Medicare IPPS Proposed Rule. This release contains a proposal by CMS to implement new metropolitan areas announced by OMB in February 2013, based on 2010 census data. If this proposal is adopted, the changes would profoundly affect many aspects of Medicare program payments.
April 28, 2014
Hidden in the recently enacted Medicare legislation is a little noticed provision that implements a new requirement applicable only to physicians ordering advanced imaging services. It will likely set the stage for new controls on the use of a wide variety of services perceived to be over-utilized and driving up Medicare costs.
April 01, 2014
On March 31, 2014, the U.S. Senate approved comprehensive Medicare legislation reauthorizing and extending dozens of Medicare payment enhancements, but also making several substantive changes that will profoundly impact affected stakeholders, including hospitals, physicians and laboratories.
April 01, 2014
On March 31, 2014, the Senate gave final approval to the Protecting Access to Medicare Act of 2014 (the Act), which includes significant reforms to the way Medicare pays for clinical diagnostic laboratory services. The House approved the Act on March 27, and the president is expected to sign the legislation.