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.
Revenue integrity experts, we want to hear from you. NAHRI is currently seeking speakers for the 2023 Revenue Integrity Symposium (RIS), to be held September 18–19, 2023, in Charlotte, North Carolina.
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.
The Office of Inspector General (OIG) recently announced it will audit CMS’ monitoring and enforcement of the Hospital Price Transparency final rule. The report is expected for release in 2023.
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.
The American Medical Association (AMA) released eight Current Procedural Terminology (CPT®) codes for Moderna and Pfizer-BioNTech’s updated COVID-19 vaccine booster doses. These boosters are adapted for the BA.4 and BA.5 omicron subvariants.
HHS recently released final rules for implementing components of the No Surprises Act. These rules expand upon several provisions of the July 2021 and October 2021 interim final rules regarding the qualified payment amount and the federal independent dispute resolution process.
