Reimbursement and Payment Methodologies

Reach your destination by planning for revenue integrity success.

Consider the financial impact of CMS’ proposals for outpatient hospital payments.

Review CMS’ proposals in the 2023 Medicare Physician Fee Schedule for changes to facility E/M coding and other coverage and reimbursement updates.

Ensure your organization is complying with CMS’ latest requirements for hospital inpatient billing and reimbursement.

Understand how revenue integrity and provider organizations can help manage rising healthcare costs.

A federal judge ruled in favor of the American Hospital Association (AHA) and other industry plaintiffs on September 28, ordering HHS to stop its reimbursement cuts to the 340B Drug Pricing Program for the remainder of the year.

On August 1, CMS issued its fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) final rule, applying to discharges occurring on or after October 1, 2022.

The 2023 Inpatient Prospective Payment System (IPPS) final rule, which takes effect October 1, includes updates to payment rates, MS-DRGs, and a number of quality and reporting programs.

CMS is weighing an expansion of the hospital outpatient department prior authorization program, changes to 340B reimbursement in the wake of the Supreme Court’s decision, and alternative rate setting data among other proposals in the 2023 Outpatient Prospective Payment System (OPPS) proposed rule.