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The final rule also clarifies the definition of “reasonable and necessary.” On Jan. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule creating a new Medicare coverage and reimbursement pathway for “breakthrough” medical devices. Durable medical equipment (DME) providers and long-term care facilities (LTCFs) and hospitals that render…
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Estimated savings are $75 million over a decade. Federal officials recently announced a series of changes to the Medicare Advantage (MA) and Part D prescription drug programs they hope will save tens of millions of dollars and also allow beneficiaries to make more informed purchasing choices. The Centers for Medicare…
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Comments are being sought now. With two COVID-19 vaccines now being distributed nationwide and more on the way, in addition to what are sure to be forthcoming enhancements in treatment of the virus, federal officials have issued an interim final rule with comment period establishing add-on payments for such measures.…
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Federal officials recently announced a flurry of regulatory changes. Recent federal regulatory changes governing the Physician Fee Schedule (PFS), reporting on total knee arthroplasty (TKA), and coverage of the use of artificial hearts have all made headlines during recent weeks – matters that may have flown under the radar considering…
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Legal arguments serving as the foundation of the filing are of questionable merit. A few weeks ago, I wrote about the new rule issued in the Nov. 27 Federal Register. You can find the regulations at 84 Fed. Reg. 65,524. The rule, which takes effect Jan. 1, 2021, will require…
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CMS clearly is honing-in on reducing administrative burden as changes go into effect.  On Friday, Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) Final Rule for the 2020 calendar year. While the official Federal Register version won’t be available until Nov. 15,…
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Final Rule covers a wide range of payment and other provisions. The Centers for Medicare & Medicaid Services (CMS) wrapped up last week by unveiling a final rule associated with the Medicare Physician Fee Schedule (MPFS) and new policies governing the functions of the payment systems for the Outpatient Prospective…
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CMS E&M FAQ is likely to generate more questions than answers. Since the release by the Centers for Medicare & Medicaid Services (CMS) of the 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, many of us have been scurrying around trying to make sense of two evaluation and management (E&M)…
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Skilled service must be is reasonable and medically necessary on a daily basis. Years ago – when I was first entering healthcare and pilgrims were coming over on the Mayflower – the Centers for Medicare & Medicaid Services (CMS) initiated a sea change in the manner in which skilled nursing…