On July 14, 2025, CMS issued a proposed rule that identifies and seeks public comment on a variety of proposed changes to the Medicare Physician Fee Schedule (PFS), Medicare Shared Savings Program Requirements, and Medicare...more
A recent OIG report found that diagnoses reported in 2022 Medicare Advantage (MA) encounter data based only on health risk assessments (HRA) and HRA-linked chart reviews resulted in CMS making additional risk-adjusted...more
On July 10, 2024, CMS issued a proposed rule that identifies and seeks public comments on a broad array of proposed changes to the Medicare Physician Fee Schedule (PFS) and Medicare Part B payments (the Proposed Rule) for...more
7/22/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Medicare ,
Medicare Part B ,
Mental Health ,
Opioid ,
Physician Fee Schedule ,
Prescription Drugs ,
Proposed Rules ,
Substance Abuse ,
Telehealth
CMS’s Hospital Price Transparency regulations require hospitals to make public the standard charges of the items and services that they provide. In the CY 2024 Hospital Outpatient Prospective Payment System Final Rule (CY...more
On December 4, 2023, CMS issued an interim final rule (the Interim Rule) (RIN 0938-AV26) to implement new enforcement authorities that CMS may use if states fail to comply with new reporting requirements or with federal...more
12/15/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Enforcement ,
Families First Coronavirus Response Act (FFCRA) ,
FMAP ,
Interim Final Rules (IFR) ,
Medicaid ,
Public Health Emergency ,
Reporting Requirements ,
Social Security Administration (SSA)
On October 11, 2023, CMS published a final rule (the Final Rule) regarding how and when CMS will impose civil monetary penalties (CMPs) for Medicare secondary payers (MSPs) that untimely report required information. The Final...more
10/19/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Employer Group Health Plans ,
Final Rules ,
Medicare ,
Medicare Beneficiaries ,
Medicare Secondary Payer Act ,
Reimbursements ,
Social Security Act ,
Statute of Limitations
On September 20, 2023, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) announced the Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee...more
On February 16, 2023, the U.S. District Court for the Northern District of Indiana rejected certain hospitals’ challenge to CMS’s calculation of uncompensated care (UCC) payments eligible to hospitals that treat low-income...more
On September 27, 2022 and October 3, 2022, CMS announced additional resources and flexibilities available for Florida and South Carolina in response to the aftermath of Hurricane Ian.
Following the President’s...more
On May 6, 2022, the Centers for Medicare & Medicaid Services (CMS) approved state plan amendments submitted by Tennessee and South Carolina through which those states will now provide 12 months of continuous postpartum...more
On January 21, 2022, Georgia sued HHS over its withdrawal of the approval of the work requirement policy as a requirement for Medicaid eligibility in the Georgia Pathways to Coverage demonstration. As previously reported, in...more
On November 2, 2021, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year (CY) 2022; makes significant changes to the provider...more
11/17/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Healthcare ,
Healthcare Reform ,
Home Health Care ,
Hospice ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Inpatient Rehab Facilities ,
Long Term Care Facilities ,
Medicare ,
Regulatory Requirements ,
Therapeutic Services ,
Value-Based Purchasing