Reimbursement and Payment Methodologies

Review E/M documentatin changes in the 2020 Medicare Physician Fee Schedule final rule.

Review changes to supervision in the 2020 Medicare Physician Fee Schedule final rule.

Learn how to establish revenue integrity best practices for Medicaid populations.

Take a look at federal Medicaid guidance and learn how to find guidance for your state's program.

CMS is automatically reprocessing 2019 hospital claims for certain services provided at grandfathered off-campus provider-based departments (PBD) after a federal judge vacated portions of the 2019 outpatient prospective payment system (OPPS) final rule. However, the agency has filed an appeal and the same federal judge declined to strike down cuts for those services planned for 2020.

As 2019 draws to a close, and as revenue integrity professionals and their organizations look to the future, an important set of decisions and changes await. Among the largest is that to come in 2021 when the new price transparency requirements for hospitals will be in place. CMS finalized the changes in the CY 2020 Hospital Outpatient Prospective Payment System (OPPS) Policy Changes: Price Transparency Requirements for Hospitals to Make Standard Charges Public final rule. 

CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1.

CMS is accepting comments until November 29 on a proposal to collect acquisition cost data from hospitals participating in the 340B drug discount program.

A federal judge rejected CMS’ motion to reconsider or issue a stay on her September order to vacate cuts to reimbursement to grandfathered off-campus provider-based departments.

CMS’ proposal mandating the disclosure of negotiated charges between hospitals and payers may exceed the agency’s legal authority and would have limited benefit to patients, according to the AHA.