Reimbursement and Payment Methodologies

CMS is proposing a 3.4% reduction to the Medicare Part B conversion factor in the 2024 Medicare Physician Fee Schedule (MPFS) proposed rule. The agency is also floating expanded telehealth and dental coverage among numerous other changes.

CMS could pay certain eligible hospitals approximately $9 billion in total as part of its plan to remedy unlawful cuts to the 340B drug discount program between 2018 and 2022, according to a proposed rule. However, the remedy would come at the cost of cuts to non-drug items and services reimbursed under the Outpatient Prospective Payment System (OPPS) starting in 2025.

Strengthen your revenue integrity team.

Take a closer look at how CMS’ proposed payment changes could impact hospital reimbursement and revenue integrity workflows.

Ensure compliance and protect revenue by making the right revenue code choices

CMS is proposing a coverage pathway to achieve expedited and more predictable access to new medical technologies for Medicare beneficiaries.

A group of senators recently sent a letter to stakeholders to seek input on improving the 340B drug pricing program.

Ronald Hirsch, MD, FACP, CHCQM, CHRI, discusses strategies for complying with payers' rules for observation services.

A bipartisan group of over 30 senators recently wrote a letter to CMS to ask the agency to reevaluate the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) proposed rule.