More payers and providers are using the independent dispute resolution (IDR) process than the government anticipated to settle payment for items and services covered by the No Surprises Act.
The Office of Inspector General (OIG) recently released its annual report on solutions to reduce fraud, waste, and abuse in HHS programs. In the OIG’s 2022 report, 16 of the top 25 unimplemented recommendations involve CMS, with three relating to Medicare Parts A and B.
CMS released a proposed rule on December 6 to promote transparency, efficiency, and automation in prior authorization processes. Certain requirements in the proposed rule are also intended to improve data accessibility for patients, providers, and payers.
CMS extended enforcement discretion, pending future rulemaking, for providing good faith estimates (GFE) for uninsured or self-pay patients that include price estimates from co-providers or co-facilities. The agency announced the pause in a December 2 FAQ, citing technical limitations.
CMS recently released new hospital price transparency sample formats. The formats, which come in wide, tall, and plain, may be used by hospitals to meet the requirement to make standard charges publicly available in a machine-readable file.
Automation and similar technologies are increasingly prevalent in revenue integrity but understanding best practices and long-term implications is still a major challenge. Learn how one organization is tackling misconceptions to make breakthroughs in deploying automation.
CMS finalized a higher-than-proposed payment increase that was almost erased for most non-drug services to offset ending reduced reimbursement for 340B drugs, according to the 2023 Outpatient Prospective Payment System (OPPS) final rule. Provisions of the rule, released November 1, also detail significant changes to payment for software as a service (SaaS) and behavioral and rural health programs, such as the rural emergency hospital (REH) designation, among other updates.
CMS is moving ahead with major changes to evaluation and management (E/M) services, telehealth, coverage of dental services, and more in the 2023 Medicare Physician Fee Schedule (MPFS) final rule. The rule, released November 1, also includes updates to vaccine payments and quality and reporting programs.
The Medical Group Management Association (MGMA) released its Annual Regulatory Burden Report on October 11. Executives from over 500 group practices said prior authorization and surprise billing requirements were the most burdensome to implement this year.
