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
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Financial Services Industry ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Payment Systems ,
Proposed Rules ,
Regulatory Requirements ,
Reporting Requirements
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-13271]...more
7/17/2025
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Healthcare Reform ,
Insurance Industry ,
Medicare ,
Medicare Part B ,
Medicare Shared Savings Program ,
New Regulations ,
Physician Fee Schedule ,
Proposed Rules ,
Regulatory Agenda ,
Technology ,
Telehealth
The American Medical Association (AMA) CPT®* Editorial Panel will convene in Chicago, Illinois, from September 18 to 20, 2025. The meeting agenda includes proposals to create new current procedural terminology (CPT) codes and...more
7/16/2025
/ Algorithms ,
Artificial Intelligence ,
Coding ,
Healthcare ,
Healthcare Facilities ,
Healthcare Reform ,
Medical Records ,
Medicare ,
Physicians ,
Reimbursements ,
Technology
The last week of June was a busy one when it comes to news about prior authorization – a major tool used by health plans and the federal government to manage healthcare utilization. The week started with a commitment from...more
7/10/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Fee-for-Service ,
Fraud ,
Government Agencies ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Medicare Advantage ,
Prior Authorization ,
Regulatory Reform ,
Waste
July 2, 2025 – There has been a lot of talk recently about the future of the Medicare Physician Fee Schedule (PFS) conversion factor (CF) – the standardized dollar amount used to convert relative value units (RVUs) into...more
It’s getting hot outside, which means that the summer regulatory season is almost upon us. In June or July, the Centers for Medicare & Medicaid Services (CMS) will release proposed regs impacting Medicare payments in...more
5/22/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Payment Systems ,
Physician Fee Schedule ,
Proposed Legislation ,
Proposed Regulation ,
Proposed Rules ,
Quality Payment Program (QPP) ,
Regulatory Reform
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
The American Medical Association (AMA) CPT®1 Editorial Panel will meet in Brooklyn, New York, from May 1 to 3, 2025. The meeting agenda includes proposals to create new current procedural terminology (CPT) codes and to revise...more
The Trump administration will have its own vision on value-based care, creating specific priorities for the Center for Medicare & Medicaid Innovation (CMMI), the federal government’s primary testing ground for payment and...more
2/26/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Trump Administration ,
Value-Based Care ,
Value-Based Payments
While we all are focused on the election results, let’s take a quick break to digest some regs and eggs. The Centers for Medicare & Medicaid Services (CMS) “spoiled” all of us in the health policy world with a huge buffet of...more
11/7/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Medicare Shared Savings Program ,
Mental Health ,
MIPS ,
New Regulations ,
Outpatient Prospective Payment System (OPPS) ,
Physician Fee Schedule ,
Telehealth
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
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more
Have Medicare physician fee-for-service payment rates increased for X-ray services? How have remote patient monitoring prices evolved over the last five years? How much is your service paid in Alaska compared to Alabama?...more
On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) posted the Hospital Inpatient Prospective Payment System (IPPS) final update for fiscal year (FY) 2025, along with proposed policy and regulation changes....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
The major calendar year proposed regs are now out, with thousands of pages of text to digest. Since a plethora of issues are embedded in these regs, including the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) and the...more
On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more
On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more
School is out and it is summertime, which means only one thing in the health policy community: reg season! This is the time of the year when the Centers for Medicare & Medicaid Services (CMS) releases regulations that propose...more
6/19/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Medicare ,
MIPS ,
New Regulations ,
Physician Fee Schedule ,
Physicians ,
Regulatory Agenda ,
Telehealth
May 11, 2024, marked one year since the end of the COVID-19 public health emergency (PHE), and not much has changed in Medicare telehealth policy. We are still operating under temporary waivers and flexibilities and, as a...more
5/15/2024
/ Controlled Substances ,
Coronavirus/COVID-19 ,
DEA ,
Electronic Prescribing ,
Health Care Providers ,
Health Savings Accounts ,
Healthcare ,
Legislative Agendas ,
Life Sciences ,
Mental Health ,
Patient Access ,
Pharmaceutical Industry ,
Prescription Drugs ,
Public Health Emergency ,
Telehealth ,
Telemedicine
Site neutral payment proposals are currently a key topic among policymakers. This +Insight explores how Medicare fee-for-service (FFS) site-of-service patterns vary across states and metropolitan statistical areas (MSAs). Our...more
Introduction-
Site neutral payment proposals may affect access differently across patient populations. In this +Insight, we focus on how site-of-service patterns for drug administration services, which both the Medicare...more
3/1/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Legislative Agendas ,
Medicare ,
MedPAC ,
Outpatient Prospective Payment System (OPPS) ,
Regulatory Agenda ,
Rural Areas ,
Site-Neutral Exception
Total Medicare expenditures are projected to exceed $1 trillion in 2023 and grow at an average rate of 7.8% per year from 2025 to 2031. Federal health policymakers, including Congress, are looking for ways to rein in spending...more
On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more
On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule [CMS-1786-FC]. The...more