On April 11, 2025, CMS proposed a rule that would update policies and payment rates used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for FY 2026 (Proposed Rule). The Proposed Rule also proposes...more
On January 3, 2025, OIG posted the results of an audit that found that Medicare could have saved $7.7 billion if critical access hospitals’ (CAH) payments for swing-bed services were similar to those of the fee-for-service...more
1/22/2025
/ Audits ,
Bi-Partison Balanced Budget Act (BBA) ,
Centers for Medicare & Medicaid Services (CMS) ,
Critical Access Hospitals ,
Fee-for-Service ,
Health Care Providers ,
Healthcare Costs ,
Healthcare Facilities ,
Hospitals ,
Medicare ,
OIG ,
Payment Systems ,
Rural Health Care Providers ,
Skilled Nursing Facility
On December 11, 2024, the Ninth Circuit struck down an HHS policy that boosted the wage index, and therefore the Medicare reimbursement rate, for hospitals in low-income communities in Kaweah Delta Health Care District v....more
12/20/2024
/ Administrative Procedure Act ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Hospitals ,
Interim Final Rules (IFR) ,
Medicare ,
Minimum Wage ,
Reimbursements ,
Summary Judgment ,
Wage and Hour
On September 24, 2024, OIG released a report recommending that CMS exercise additional oversight of remote patient monitoring (RPM) services provided to Medicare beneficiaries. Medicare reimburses RPM for any chronic or acute...more
On August 12, 2024, OIG announced the results of an audit of payments made to hospitals for inpatient claims with the Medicare Severity Diagnosis-Related Groups (MS-DRGs) that require ninety-six hours of consecutive...more
8/30/2024
/ Audits ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Extrapolation ,
Hospitals ,
Inpatient Billing ,
Inpatient Rehab Facilities ,
Medicare ,
OIG ,
Overpayment ,
Policies and Procedures