Reimbursement and Payment Methodologies

Understand the far-reaching financial and operational impacts of sunsetting the inpatient-only (IPO) list.

Some providers appear to be struggling with “how” and “whether or not” to bill for COVID-19 vaccine administrations. On March 15, 2021, CMS increased the per-injection reimbursement to $40. CMS has recognized that there is added cost to the administering provider because of the increased resources involved in mass immunizations required to control a pandemic. 

CMS recently boosted Medicare payments for COVID-19 vaccines as part of an effort to accelerate vaccinations.

Six codes for telehealth services are newly eligible to reported with modifier -CS (cost-sharing), which requires Medicare to cover beneficiary cost-sharing during office visits and other encounters for the duration of the public health emergency.

A study published late last year by the Urban Institute forecasted that over 10 million families would lose their employer-sponsored health insurance during the novel coronavirus (COVID-19) pandemic. As a result, healthcare organizations have observed a growing number of uninsured patients and a rise in out-of-pocket responsibility.

Most off-campus provider-based departments (PBD) that claimed the mid-build exception under the 21^st Century Cures Act failed to meet the requirements and have likely received overpayments, according to CMS.

CMS recently released FAQs clarifying how it will collect data on market-based MS-DRG relative weights and changes to its methodology for calculating MS-DRG relative weights.