Healthcare payment policy and regulation
Payment policy and regulation encompasses the various rules, guidelines and laws governing healthcare's financial aspects, including Medicare and Medicaid reimbursement rates, medical billing, and claims administration. Payment policy and regulation also plays a critical role in shaping the healthcare landscape, affecting service accessibility and affordability.
Top Stories
-
News
04 Nov 2024
CMS highlights maternal care in CY 2025 OPPS, ASC final rule
The CMS CY 2025 OPPS, ASC final rule aims to reduce maternal mortality, remove barriers to care for formerly incarcerated individuals and enhance health equity. Continue Reading
By- Jill McKeon, Associate Editor
-
News
04 Nov 2024
CMS finalizes CY 2025 Medicare physician fee schedule rule
CMS issued the CY 2025 Medicare physician fee schedule final rule, which included updates to payment policies and average payment rate reductions. Continue Reading
By- Jill McKeon, Associate Editor
-
News
28 Jul 2022
CMS Releases FY23 Final Rules for Hospice Providers, IPFs, IRFs
The final rules for fiscal year 2023 include a 3.8 percent payment increase for hospice providers, 2.5 percent increase for inpatient psychiatric facilities, and 3.2 percent boost for inpatient rehabilitation facilities. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
27 Jul 2022
CMS Releases Quality Measure Set to Improve Home, Community-Based Care
The home- and community-based services quality measure set also aims to advance health equity and reduce health disparities for older adults and people with disabilities. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
18 Jul 2022
CMS Proposes 2.7% Increase in CY23 OPPS, ASC Reimbursement Rates
In addition to a 2.7 percent increase in reimbursement rates, CMS proposed ending the 340B Medicare reimbursement cuts in the CY 2023 OPPS and ASC proposed rule. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
13 Jul 2022
CMS Proposes Quality Payment Program Updates in CY23 PFS Rule
In addition to physician reimbursement cuts, CMS included changes to the Quality Payment Program in the CY 2023 Medicare Physician Fee Schedule proposed rule. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
11 Jul 2022
Federal Govt Received $1.9B from FY21 Healthcare Fraud Settlements
In addition to DOJ negotiating funds for healthcare fraud settlements, OIG excluded nearly 1,700 individuals and entities from participating in Medicare, Medicaid, and other federal healthcare programs. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
11 Jul 2022
Providers Face Cuts in Medicare Physician Fee Schedule Proposed Rule
The CY 2023 Medicare Physician Fee Schedule proposed rule would follow through on several cuts to physician reimbursement while aiming to bolster behavioral and ACO care. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
05 Jul 2022
New Medicare Provider Designation to Prevent Rural Hospital Closures
A new proposed rule aims to create a unique Medicare provider designation to avert rural hospital closures and increase patient access to care. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
30 Jun 2022
Medicare, Medicaid to Take Closer Look at Nursing Home Staffing
CMS provided updated guidance on minimum health and safety standards as part of Medicare and Medicaid participation, with new measures focusing largely on nursing home staffing. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
28 Jun 2022
CMS Releases FAQ for No Surprises Act Implementation, Requirements
The No Surprises Act FAQ states that balance billing protections do not apply to individuals with public healthcare coverage and notice and consent forms must be provided and received in written format. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
24 Jun 2022
Molina Healthcare Pays $4.6M to Settle False Claims Act Violations
The healthcare organization allegedly violated the False Claims Act by submitting Medicaid reimbursement claims while simultaneously violating staff qualification and supervision regulations. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
22 Jun 2022
CMS Rule to Update ESRD Medicare Reimbursement, New Care Model
The CY23 End-Stage Renal Disease (ESRD) Prospective Payment System Proposed Rule would increase Medicare reimbursement rates, among other policy changes. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
21 Jun 2022
CMS Proposes New Medicare Payment Adjustment for Home Health
The federal agency released the Home Health Prospective Payment System Rate Update proposed rule for CY23, which aims to permanently adjust Medicare payment based on PDGM. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
13 Jun 2022
Steward Health Care System Settles False Claims Act Violations
The for-profit healthcare system has settled alleged False Claims Act violations after paying physicians fraudulent kickback payments in exchange for patient referrals. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
03 Jun 2022
FTC Aims to Block Proposed Hospital Merger Between Utah Facilities
The proposed hospital merger between HCA Healthcare and Steward Health Care System would eliminate competition in Utah and raise healthcare costs for individuals, FTC said. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
03 Jun 2022
AHA Calls for Changes to FY23 Inpatient Rehabilitation Facility PPS
The payment increase for inpatient rehabilitation facility providers included in the proposed rule does not accurately reflect the financial challenges hospitals faced during the pandemic, AHA said. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
16 May 2022
Hospital Groups Ask HHS to Expand COVID-19 Public Health Emergency
Hospital groups have asked HHS to renew the COVID-19 public health emergency and the accompanying regulatory waivers to ensure healthcare providers are prepared for potential variant surges. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
10 May 2022
Home Healthcare Company Settles False Claims Act Violations
The home healthcare company allegedly violated the False Claims Act by submitting claims to Medicare for home healthcare services that beneficiaries did not need or were not eligible for. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
06 May 2022
HHS Pauses Appeal of Surprise Billing Ruling on IDR Provisions
The court has granted the request from HHS to pause its appeal against a surprise billing ruling while the department works on issuing a final rule. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
28 Apr 2022
Colorado Bill Aims to Limit Debt Collections, Boost Price Transparency
If a Colorado hospital were to attempt to collect medical debt from patients but has not been complying with the hospital price transparency rule, the facility would face financial penalties. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
25 Apr 2022
FAH Requests Hospital Merger Guideline Consistency from DOJ, FTC
While FAH requested that the agencies maintain hospital merger guidelines, the group suggested several targeted changes, such as considering quality of care improvements in merger evaluations. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
21 Apr 2022
CMS Proposes $1.6B Increase in IPPS Payment Rates for FY23
In addition to payment rate updates, the IPPS proposed rule included changes to the Hospital Readmissions Reduction Program and the Hospital-Acquired Condition Reduction Program. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
20 Apr 2022
Florida Practice Pays $24.5M to Resolve False Claims Act Violations
DOJ alleged that Physicians Partners of America violated the False Claims Act by ordering physicians to bill federal health plans for medically unnecessary urine drug tests. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
20 Apr 2022
CMS Updates Guidance for Independent Dispute Resolution Entities
Following legal pushback, CMS has clarified that independent dispute resolution entities must consider additional information during an IDR process, including provider experience and market share. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
19 Apr 2022
HHS Distributes $1.75B in Phase 4 COVID-19 Provider Relief Funds
Around 3,600 healthcare providers that have experienced pandemic-related revenue losses and expenses will receive payments through this round of Phase 4 COVID-19 Provider Relief Funds. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
18 Apr 2022
Providence Reaches $22.7M Settlement to Resolve Healthcare Fraud
The healthcare fraud settlement detailed how neurosurgeons from Providence St. Mary’s performed complex, medically unnecessary surgeries in exchange for financial incentives. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
14 Apr 2022
HHS Renews COVID-19 Public Health Emergency, Regulatory Waivers
The COVID-19 public health emergency renewal will extend regulatory waivers and flexibilities that have supported hospitals and health systems during the pandemic. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
14 Apr 2022
DOJ Alleges Methodist Violated False Claims Act, Anti-Kickback Laws
The lawsuit claims that Methodist violated the False Claims Act by billing Medicare for outpatient cancer care that the health system gained access to through a fraudulent partnership with West Clinic. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
13 Apr 2022
CMS Releases Skilled Nursing Facility PPS Proposed Rule for FY23
CMS proposed adding new quality measures to the Skilled Nursing Facility Quality Reporting Program and the Value-Based Purchasing program in the SNF PPS proposed rule for FY 2023. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
13 Apr 2022
Biden Admin Announces Plans to Alleviate Medical Debt Burden
The Biden administration will request medical billing collection information from providers and offer medical debt reporting guidance to several federal agencies to help alleviate medical debt burden. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
07 Apr 2022
AHA, AMA Ask Court to Vacate IDR Provisions in Surprise Billing Rule
The trade groups are calling on the DC District Court to vacate the surprise billing rule they say puts undue emphasis on the qualifying payment amount when determining reimbursement rates for out-of-network services. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
05 Apr 2022
Change Healthcare, UnitedHealth Extend Healthcare Merger Deadline
Following a lawsuit from the Department of Justice to block the deal, Change Healthcare and UnitedHealth Group have pushed their April 2022 healthcare merger deadline to the end of the year. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
04 Apr 2022
CMS Proposes 2.7% Payment Boost for Inpatient Psychiatric Facilities
Under the Inpatient Psychiatric Facility Prospective Payment System proposed rule, CMS requested stakeholder feedback on the IPF adjustment analysis and recommendations for health equity initiatives. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
04 Apr 2022
CMS Releases FY23 Inpatient Rehabilitation Facility PPS Proposed Rule
Under the proposed rule for the Inpatient Rehabilitation Facility Prospective Payment System, IRF providers would receive a 2.8 percent increase in Medicare payments for FY 2023. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
01 Apr 2022
CMS Increases Hospice Payment Rate in Proposed Rule for FY 2023
In addition to a new hospice payment rate, CMS updated the payment cap for hospice services and included a cap for negative wage index changes in its proposed rule for FY 2023. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
01 Apr 2022
AHA Asks DOJ, FTC for Minor Hospital Merger Guideline Revisions
In response to a request for information on hospital merger guidelines, AHA urged DOJ and FTC to modify the economic models and processes used to evaluate hospital transactions. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
30 Mar 2022
Hospital Groups Urge HHS to Renew COVID-19 Public Health Emergency
The American Hospital Association and fellow hospital groups cited ongoing staffing shortages and clinician burnout as reasons for HHS to renew the COVID-19 public health emergency. Continue Reading
By- Victoria Bailey, Xtelligent
-
Feature
29 Mar 2022
Coronavirus Healthcare Spending Dwindles, Threatening Health Equity
Congress’s failure to allocate additional healthcare spending for uninsured COVID-19 claims is a blow to health equity, access to care, and patients’ lives. Continue Reading
By- Hayden Schmidt
-
News
28 Mar 2022
Federal Appeals Court Blocks New Jersey Hospital Merger
A federal appeals court expressed similar competition concerns as the US District Court of New Jersey and blocked the proposed hospital merger between Hackensack Meridian Health and Englewood Health. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
24 Mar 2022
HHS Announces $413M in Provider Relief Fund Phase 4 Payments
More than 3,600 healthcare providers will receive funds from HHS through the fourth round of Phase 4 COVID-19 Provider Relief Funds. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
07 Mar 2022
Senate Voted to Repeal COVID-19 Healthcare Worker Vaccine Mandate
GOP lawmakers looking to repeal the COVID-19 healthcare worker vaccine mandate said that the rule was not about public health and would exacerbate staffing shortages. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
28 Feb 2022
HHS to Distribute $560M in Phase 4 COVID-19 Provider Relief Funds
The third batch of Phase 4 COVID-19 Provider Relief Funds will offer $560 million to 4,100 providers who faced revenue loss during the pandemic and serve vulnerable populations. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
25 Feb 2022
Texas Federal Judge Rules Against HHS in Surprise Billing Lawsuit
The judge sided with the Texas Medical Association in its surprise billing lawsuit that claimed the arbitration process in the HHS interim final rule goes against No Surprises Act policies. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
24 Feb 2022
DOJ Files Lawsuit to Block UnitedHealth, Change Healthcare Merger
DOJ said that the acquisition of Change Healthcare by UnitedHealth Group would hurt competition in both the commercial health insurance and the healthcare technology market. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
15 Feb 2022
FAH Urges HHS to Extend COVID-19 Public Health Emergency, Waivers
The organization indicated that the temporary regulatory waivers and flexibilities introduced during the COVID-19 public health emergency have significantly helped hospitals provide care for patients. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
10 Feb 2022
AHA to Congress: Hospitals Need More Resources Amid Financial Struggles
AHA and other hospital groups are urging congressional leaders to provide hospitals with additional resources and extend the moratorium on Medicare payment cuts to help address financial struggles. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
10 Feb 2022
Telehealth, EHR Use Increases False Claims Act Violations, Fraud
As more providers leverage telehealth services and EHR systems, the federal government has seen increased False Claims Act violations and healthcare fraud. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
08 Feb 2022
States Try Again to Block Vaccine Mandate for Healthcare Workers
Following the Supreme Court’s recent ruling, the complaint filed by 16 states seeks to prevent the federal government from enforcing the COVID-19 vaccine mandate for healthcare workers. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
01 Feb 2022
2022 Claims Reimbursement Updates in Emergency Medicine
Emergency medicine is facing a host of claims reimbursement updates this year, from looming Medicare payment cuts to new rules about split and critical care visits. Continue Reading
By- Brault Practice Solutions
-
News
01 Feb 2022
Practices Not Ready to Implement NSA’s Good Faith Estimates
MGMA is asking HHS to delay uninsured or self-pay good faith estimate requirements as medical practices navigate new administrative burdens. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
28 Jan 2022
Montana Seeks Exemptions to Vaccine Mandate for Rural Hospitals
State leaders asked the Biden Administration to issue exemptions to the vaccine mandate for healthcare workers because of the state’s largely rural communities. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
26 Jan 2022
$2B in Provider Relief Fund Payments Heading to Providers
The Provider Relief Fund payments are part of the Phase 4 General Distribution announced in December. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
25 Jan 2022
AHA to Lawmakers: Add More to the COVID-19 Provider Relief Fund
The hospital group called on Congressional leaders to replenish the COVID-19 Provider Relief Fund as part of an upcoming spending bill, among other requests. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
21 Jan 2022
DOJ, FTC Seek to Modify Merger Guidelines to Foster Competition
The merger guidelines will be updated to in an effort to avert illegal and anticompetitive deals, however the guidelines will impact future healthcare mergers. Continue Reading
By- Sarai Rodriguez
-
News
20 Jan 2022
Vaccine Mandate for Healthcare Workers Enforceable in All States
CMS’ vaccine mandate for healthcare workers can now be implemented across the country after a federal judge dismissed the state’s challenge. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
18 Jan 2022
HHS Renews COVID-19 PHE, Key Flexibilities That Come With It
HHS announced the government would extend the declaration for another 90 days, continuing government support for hospitals and health systems. Continue Reading
By- Sarai Rodriguez
-
News
18 Jan 2022
CMS Updates Healthcare Worker Vaccine Mandate Guidance
CMS said facilities in most states challenging the healthcare worker vaccine mandate must have their workers fully vaccinated by March 15. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
11 Jan 2022
Physician Groups Back AMA-AHA Lawsuit Over Surprise Billing IDR Process
The organizations urge the federal government to block the surprise billing IDR process, which will lead to more healthcare consolidation, less patient choice, and higher costs for out-of-network services Continue Reading
By- Sarai Rodriguez
-
News
07 Jan 2022
AHA Shares New Concerns with Vaccine Mandate for Healthcare Workers
AHA urges CMS to increase guidance clarity, grandfather vaccine existing processes, extend compliance dates, address supply -chain issues, and lighter consequences for non-compliance. Continue Reading
By- Sarai Rodriguez
-
News
30 Dec 2021
CMS Reinstates COVID-19 Vaccination Mandate in 25 States
The vaccine mandate will require healthcare workers in states where the mandate isn’t enjoined to be vaccinated by February 28, 2022. Continue Reading
By- Sarai Rodriguez
-
News
28 Dec 2021
HRSA Releases $48M to Boost Rural Healthcare Workforce
The award will support more than 30 community-based organizations through healthcare job development, training, and placement to increase the rural and tribal workforce in their area. Continue Reading
By- Sarai Rodriguez
-
News
21 Dec 2021
CMS Funds 1,000 New Medicare Residency Slots to Address Labor Shortage
As part of the FY 2022 IPPS Final Rule, CMS will increase the workforce in rural and underserved communities by funding 1,000 new Medicare residency slots. Continue Reading
By- Sarai Rodriguez
-
News
20 Dec 2021
Missoula Surgeon Pays $3.7M to Settle Healthcare Fraud Allegations
The vascular surgeon will pay $3.7M to settle healthcare fraud allegations involving medically unnecessary surgeries and submitting false claims. Continue Reading
By- Sarai Rodriguez
-
News
16 Dec 2021
Appeals Court Allows Healthcare Vaccine Mandate in 26 States
The decision from the US Court of Appeals for the Fifth Circuit will allow CMS to enforce the vaccine mandate for healthcare workers in about half the country. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
16 Dec 2021
HHS Distributes Another $9B from Provider Relief Fund
HHS is releasing $9Bin Provider Relief Fund payments to providers who have experienced revenue losses or increased expenses related to the COVID-19 pandemic. Continue Reading
By- Sarai Rodriguez
-
News
15 Dec 2021
Senate Scraps Medicaid DSH Cuts in Latest Build Back Better Act
The Senate Finance Committee got rid of provisions in the Build Back Better Act that would have reduced payments to Medicaid Disproportionate Share Hospitals (DSH). Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
07 Dec 2021
Surprise Billing Regulation Faces Pushback from Medical Groups
AMGA criticizes CMS’ interim final rule for unfairly favoring payers during the federal independent dispute resolution process. Continue Reading
By- Sarai Rodriguez
-
News
06 Dec 2021
CMS Suspends COVID-19 Vaccine Mandate for Healthcare Workers
The federal agency released a memorandum suspending the COVID-19 vaccine mandate for healthcare workers following two court rulings against the rule. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
01 Dec 2021
Courts Block COVID-19 Vaccine Mandate for Healthcare Workers
A federal court granted a preliminary injunction stopping CMS from enforcing a COVID-19 vaccine mandate for healthcare workers in 10 states that challenged the rule. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
30 Nov 2021
Rural Healthcare Providers Get $7.5B in COVID-19 Relief Funds
The Biden Administration is distributing COVID-19 relief funds from the American Rescue Plan to rural providers who serve Medicaid, CHIP, and Medicare beneficiaries. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
24 Nov 2021
Administration Invests $1.5B to Address Healthcare Workforce Shortage
The $1.5B investment will support equitable healthcare by addressing healthcare workforce shortages in underserved communities. Continue Reading
By- Sarai Rodriguez
-
News
22 Nov 2021
HHS to Form Ambulance Billing Advisory Committee, Per No Surprises Act
The federal department will form a federal advisory committee to address ground ambulance billing practices as part of No Surprises Act implementation. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
22 Nov 2021
Bipartisan Bill Addresses Distribution Delays in Provider Relief Fund
The bill would ensure billions left in the untouched Provider Relief Fund will be distributed to healthcare providers. Continue Reading
By- Sarai Rodriguez
-
News
17 Nov 2021
MGMA Calls on Congress to Prevent Impending Medicare Cuts
Medical group practices urge Congress to avert Medicare cuts included in the Medicare Physician Fee Schedule rule. Continue Reading
By- Sarai Rodriguez
-
News
16 Nov 2021
CMS Sued by Ten States Over Vaccine Mandate for Healthcare Workers
A group of ten states filed a federal lawsuit seeking to block CMS’ interim final rule containing the COVID-19 vaccine mandate for healthcare workers. Continue Reading
By- Sarai Rodriguez
-
News
12 Nov 2021
CMS Rescinds Rule Expediting Medicare Coverage of Breakthrough Devices
The Trump-era rule would have granted expedited Medicare coverage for up to 4 years for certain FDA-designated breakthrough devices. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
09 Nov 2021
Lawmakers Seek Changes to No Surprises Act Implementation
More than a third of Representatives call on the federal government to revise No Surprises Act implementation, specifically around the independent dispute resolution process Continue Reading
By- Sarai Rodriguez
-
News
04 Nov 2021
CMS Issues COVID-19 Vaccine Mandate for Healthcare Workers
The interim final rule will require COVID-19 vaccination from 76K providers and over 17M healthcare workers employed by facilities participating in Medicare and Medicaid. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
04 Nov 2021
Texas Medical Association Sue Feds Over IDR for Surprise Billing
The Association accuses the federal authorities of failing to follow “clear direction” on how to implement the independent dispute resolution process in the surprise billing law. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
03 Nov 2021
CMS Releases Final Rule for CY 2022 Medicare Physician Fee Schedule
The CY 2022 Medicare Physician Fee Schedule final rule promotes greater telehealth utilization and boosts payment rates for vaccine administration. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
03 Nov 2021
Hospital Price Transparency Penalties to Increase Under OPPS Rule
The Medicare OPPS final rule will also boost hospital outpatient reimbursement by 2% and add back the Inpatient Only List, among other changes. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
14 Oct 2021
AHA Urges Congress to Uphold Current Merger and Acquisition Guidelines
AHA and other organizations asked Congress not to alter the current merger and acquisition guidelines, as more government control could create additional roadblocks for businesses and hurt the market. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
01 Oct 2021
HRSA Opens Application for Provider COVID-19 Relief Funds
Healthcare providers can use the online portal to apply for COVID-19 relief funds from the American Rescue Plan and the Provider Relief Fund. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
30 Sep 2021
Independent Dispute Resolution Detailed in New Surprise Billing Rule
The interim final rule will implement provisions of the No Surprises Act, which bans surprise billing and determines provider out-of-network rates based on an arbitration process. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
16 Sep 2021
AHA Pens Oppositions to 2022 Physician Fee Schedule Proposed Rule
The organization is concerned about policies in the 2022 Physician Fee Schedule proposed rule, ranging from telehealth worries to apprehension about MIPS. Continue Reading
By- Victoria Bailey, Xtelligent
-
News
14 Sep 2021
CMS to Repeal Medicare Coverage of Breakthrough Devices Rule
The rule is slated to establish a Medicare coverage pathway for breakthrough medical devices and provide standards for “reasonable and necessary” services. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
14 Sep 2021
HHS Proposes More Surprise Billing Compliance Rules
The rules address surprise billing compliance for next year, including how state and federal laws will work together and when providers could face penalties. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
13 Sep 2021
HHS Announces Plan to Distribute $25.5B in COVID-19 Provider Relief
The announcement comes on the heels of industry groups and lawmakers asking HHS to distribute remaining COVID-19 provider funding. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
10 Sep 2021
CMS to Tie Vaccine Mandate to Medicaid, Medicare Participation
The Biden-Harris Administration said it will require COVID-19 vaccines for staff within all Medicaid and Medicare-certified facilities as a condition of participation. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
08 Sep 2021
What the No Surprises Act Means for Providers
HHS announced the first part of the Surprise Billing Final Rule effective January 1, 2022. But implementing the requirements under the No Surprises Act is no small feat for provider organizations. Continue Reading
By- Emily Sokol, MPH
-
News
24 Aug 2021
CMS Ups Medicare Payment for At-Home COVID-19 Vaccinations, Again
The Medicare payment rate was boosted again to incent COVID-19 vaccinations among beneficiaries who have trouble accessing vaccines outside of their homes. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
20 Aug 2021
Leaked CMS Report Targets Medicare Noncompliance at CA Hospital
A leaked CMS report targeting HCA Healthcare-owned Good Samaritan Hospital in California warns the hospital to fix Medicare noncompliance issues or risk termination. Continue Reading
By- Jill McKeon, Associate Editor
-
News
19 Aug 2021
OIG: CMS Should Remove IPPS New Hospital Capital Cost Exemption
An OIG audit revealed that the IPPS new hospital capital cost exemption caused Medicare to incur up to $423.2 million in costs between 2012 and 2018. Continue Reading
By- Jill McKeon, Associate Editor
-
News
18 Aug 2021
MGMA Calls on CMS to Prevent EFT Fees, Predatory Business Tactics
CMS should use its authority to prohibit EFT fees and predatory business tactics imposed on medical groups by payers, MGMA said in a recent letter. Continue Reading
By- Jill McKeon, Associate Editor
-
News
17 Aug 2021
CMS Holds Off on Hospital Price Transparency Noncompliance Penalties
CMS will hold off on hospital price transparency noncompliance penalties for the time being in order to give hospitals time to adjust to the new rule. Continue Reading
By- Jill McKeon, Associate Editor
-
News
17 Aug 2021
AHA Addresses No Surprises Act Patient Notice and Consent Provisions
Steps must be taken to ensure that notice and consent and public disclosure forms under the No Surprises Act are clear for both patients and providers, AHA stated. Continue Reading
By- Jill McKeon, Associate Editor
-
News
10 Aug 2021
AHA Cites Antitrust Concerns Over UnitedHealth-Change Healthcare Deal
AHA sent a letter to DOJ’s Antitrust Division expressing concern over UnitedHealth Group’s impending acquisition of Change Healthcare and its implications. Continue Reading
By- Jill McKeon, Associate Editor
-
Answer
03 Aug 2021
How Policy, Regulation Will Challenge Consolidation in Healthcare
A new executive order is putting consolidation in healthcare in the spotlight; industry experts share what policy and regulation will mean for provider merger and acquisition activity. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
02 Aug 2021
IPPS Final Rule Bumps Hospital Reimbursement, COVID-19 Rates
The FY 2022 IPPS final rule will increase hospital reimbursement by 2.5%, while also boosting rates for COVID-19 diagnostics and therapies. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
30 Jul 2021
CMS Drops 4 FY22 Medicare Payment Rules: SNF, Hospice, IRF, IPF
The four final Medicare payment rules for FY 2022 will increase rates for skilled nursing facilities, hospices, inpatient rehabilitation facilities, and inpatient psychiatric facilities. Continue Reading
By- Jacqueline LaPointe, Director of Editorial
-
News
29 Jul 2021
Senators Introduce Provider Relief Fund Deadline Extension Act
Two Senators introduced the Provider Relief Fund Deadline Extension Act, a bill that would allow healthcare providers to use PRF funds through at least December 31st. Continue Reading
By- Jill McKeon, Associate Editor