Tag: FFS

HHS Distributes $30 Billion to FFS Medicare Providers

On April 10, 2020, the US Department of Health and Human Services (HHS) began distributing $30 billion from the $100 billion Public Health and Social Services Emergency Fund to Medicare fee-for-service (FFS) providers. The Coronavirus Aid, Relief, an...

CMS Announces CY 2021 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies

On April 6, 2020, the Centers for Medicare and Medicaid Services released the annual capitation rates for calendar year 2021 for Medicare Advantage (MA) and Part D. The agency states these adjustments and new policies will continue to advance, modern...

Direct Contracting Office Hours on Feb 11

On February 11, 2020, the Center for Medicare and Medicaid Innovation (Innovation Center) will host office hours on the Direct Contracting model’s payment methodology. During this second session—the second in a two-part series—the Direct Contra...

CMS Seeks to Expand Services through Recent Coverage Decisions (Acupuncture for Low Back Pain and NGS for Advanced Breast and Ovarian Cancer)

The Centers for Medicare and Medicaid Services has announced two coverage decisions that will provide access to previously uncovered services for Medicare fee-for-service (FFS) beneficiaries. On January 21, 2002, CMS released a decision memo to cove...

CMS Reports on Rates of Social Determinants of Health Coding on FFS Claims in 2017

CMS began collecting data on social determinants of health (SDOH) through the use of z-codes in 2016. The agency reported that among 33.7 million total Medicare FFS beneficiaries in 2017, approximately 1.4% had claims with Z codes. SDOH indicators ar...

CMS Issues Decision Memo Broadening Coverage of Next Generation Sequencing Testing for Advanced Breast and Ovarian Cancer

CMS issues its decision memo that revises and expands on the coverage for next generation sequencing (NGS) as a diagnostic laboratory test for ovarian and breast cancer when selected criteria are met. This expansion of coverage builds on the origina...

MedPAC Considers 2021 Payment Updates for Doctors and Hospitals and Discusses MA

The Medicare Payment Advisory Commission (MedPAC) met on December 5, 2019, to discuss 2021 payment updates for physicians, inpatient and outpatient hospital services and the annual update on the status of Medicare Advantage (MA) as they prepare their...

MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting

The Medicare Payment Advisory Commission (MedPAC) met in Washington, DC on November 6-7, 2019. The Commission continued a discussion on redesigning the Medicare Advantage (MA) quality bonus program (QBP).  

MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting

The Medicare Payment Advisory Commission (MedPAC) met in Washington, DC on November 6-7, 2019. The Commission continued a discussion on redesigning the Medicare Advantage (MA) quality bonus program (QBP). Redesigning the Medicare Advantage (MA) q...

CMS Issues Proposed Decision Memo on Reconsidered Next Generation Sequencing National Coverage Determination

CMS issues a proposed decision memo that would revise and expand on the coverage for next generation sequencing (NGS) as a diagnostic laboratory test for ovarian and breast cancer when selected criteria are met. The proposed decision memo would revis...

CMS Solicits Comments on the Future of Medicare Program Integrity

As a follow-up to the recently released Presidential Executive Order on Medicare, the Centers for Medicare and Medicaid Services (CMS) released two requests for information (RFIs) on the future of Medicare program integrity. For CMS, the focus of Med...

2018 MIPS Final Scores Impacting 2020 Medicare FFS Payments Now Available

The Centers for Medicare and Medicaid Services (CMS) released final scores for the 2018 Merit-based Incentive Payment System (MIPS). An eligible group or individual clinician’s performance in the 2018 MIPS program will result in upward, downward or...

CPC+ First Annual Report Posted

The Centers for Medicare and Medicaid Services (CMS) released the first annual report of the Comprehensive Primary Care Plus (CPC+) payment model. CPC+ is the largest primary care payment and delivery reform ever tested in the US. In January 2017 it ...