CMS recently released the final rule for the Medicare Physician Fee Schedule. Before I dive into the specifics of the recently released 2019 final rule for evaluation and management (E&M) services, allow me to quickly speak to three elements that the Centers for Medicare & Medicaid Services (CMS) has not…
THIS STORY HAS CORRECTED TO REFLECT THE NOV. 2 RELEASE OF THE FINAL FOR 2019 EDITOR’S NOTE: CMS on Thursday released the 2019 Medicare Physician Fee Schedule. For 2019 and 2020, we will see no changes to our outpatient, office-based evaluation and management (E&M) services, but things will change come…
Release by CMS caps months of debate by stakeholders Long awaited and hotly debated, the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) final rules have been on the minds of healthcare shareholders since late July, when the Centers for Medicare & Medicaid Services (CMS) released proposed rules…
The Centers for Medicare & Medicaid Services (CMS) wants to modernize the Medicare Advantage and Part D programs, as well as launch an ambitious expansion of telehealth benefits, according to a proposed rule the agency issued last week. Medicare Advantage (MA) and Part D provide seniors with health and prescription…
CAR-T therapy could list a single service with a $1.4 million charge. I was honored to be able to speak at the annual meeting of the National Association of Healthcare Revenue Integrity in Arizona in mid-October. Since the audience was a group of hospital revenue staff, I used my session…
More than a third of ACOs might leave if the proposed rule takes effect. The comment period closed for the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) proposed rule on Oct. 16. The MSSP has been a controversial program since its inception. The chief concern…
Monday was the last day that CMS could have finalized the rule changes, per law. Three years ago this week, the hospital case management world was sent into turmoil by the release of CMS-3317-P, a 125-page Centers for Medicare & Medicaid Services (CMS) proposed rule titled “Revisions to Requirements for…
TPE audits appear to be on the rise. The old baseball adage, “three strikes and you’re out,” now has relevance in the Medicare audit arena. Targeted probe and educate (TPE) audits are the latest type of audits facing Medicare providers and suppliers. TPE audits are unique in that, unlike other…
Does healthcare IT really improve medical care? Today we present the first in a series of articles that will explore how information technology (IT) is one of the most egregious enablers of the high cost of medical care in the United States. This series is inspired by a recent hospitalization…
The final rule on provider-based clinics is expected in early November. To understand changes being made relative to provider-based clinics, both Federal Registers must be read, and due to the complexity of the language, studied with care. Note that these are proposed rule changes. We will have to wait until…