CMS recently relaunched the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals, restoring these facilities’ access to a valuable data tool that assists with claim accuracy.Read More »
CMS recently created a new system edit to help reduce improper Medicare payments for outpatient services provided by acute care hospitals to hospice patients.Read More »
CMS moved ahead with significant expansions to its site neutral payment policies, including reductions to payments for certain services at expected off-campus provider based departments (PBD), additional price transparency requirements, changes to its methodology for setting MS-DRG rates, and...Read More »
After receiving negative feedback from industry stakeholders on its new reimbursement approach for certain inpatient Medicare Advantage (MA) claims, Aetna recently extended the policy’s implementation date.Read More »
Part B reimbursement is set for significant changes starting January 1, 2026, according to the 2026 Medicare Physician Fee Schedule (MPFS) final rule, released October 31. The final rule includes numerous major changes to how CMS will calculate reimbursement, updates to telehealth services, and...Read More »
CMS directed Medicare Administrative Contractors (MAC) to lift the claims processing hold issued earlier this month for certain services impacted by the government shutdown.Read More »
Medicare could have saved over $300 million if bundled payments for opioid use disorder (OUD) treatments more accurately reflected the services provided, according to a recent Office of Inspector General (OIG) audit report.Read More »
