CMS has resumed testing of the activation of systematic validation edits for outpatient providers with multiple service locations. After postponing testing during the public health emergency, the agency conducted a fifth round of tests in May and revealed it is moving forward with the full production implementation of these edits.
CMS released compliance tips for pre-entitlement billing in a recent edition of its MLN Connects® newsletter. The agency instructed providers to use these billing instructions for inpatient admissions when the patient is admitted before their Medicare Part A entitlement date and discharged after that date.
CMS is doubling down on price transparency compliance and enforcement, according to the 2024 Outpatient Prospective Payment System (OPPS) proposed rule. The proposed rule also details major changes to price transparency requirements and behavioral health reimbursement, coverage of dental services, and more.
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.
Hospitals have made significant efforts to comply with price transparency regulations due to increased civil monetary penalties from CMS, according to a recent JAMA Network Open study.
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.
