Last week, the Centers for Medicare & Medicaid Services (CMS) issued two major regs: the calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) proposed rule and the CY 2026 Outpatient Prospective Payment System (OPPS)...more
7/24/2025
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Trump Administration
On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1834-P],...more
7/18/2025
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Healthcare Reform ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
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Reporting Requirements
On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2026 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment...more
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule [CMS-1809-F],...more
What are the cost drivers for different ambulatory services? How much does Medicare pay for outpatient knee replacements? How has Medicare volume changed over time for outpatient GI procedures? ...more
On September 24, 2024, the Office of Inspector General (OIG) at the US Department of Health and Human Services issued a report recommending additional oversight of remote physiologic monitoring (RPM) services furnished to...more
The CPT® Editorial Panel will meet in Albuquerque, New Mexico, from September 19 to 21, 2024. As published by the American Medical Association (AMA), the meeting agenda includes proposals to create new current procedural...more
Over the last several weeks, the Biden administration has released numerous final regulations in order to “beat the clock” before it ticks down to the Congressional Review Act (CRA) deadline. The CRA authorizes Congress to...more
5/9/2024
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American Health Care Act (AHCA) ,
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U.S. House
Sharpen your pencils and locate your reading glasses: the final Medicare payment regulations for calendar year (CY) 2024 will be released within the next week.
In the last Regs & Eggs blog post, I discussed a major issue...more
10/26/2023
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Drug Pricing ,
Health Care Providers ,
Hospitals ,
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Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Physician Fee Schedule ,
Price Transparency ,
Regulatory Agenda ,
Regulatory Requirements ,
Section 340B