Often overlooked is the line-item price reduction step, particularly related to partial or 50 percent-or-greater credits. It was inevitable: just when hospitals were getting comfortable with their policies and procedures for reporting implantable medical device credits, even to the point of congratulatory back-slaps for meticulously following all related compliance steps,…
November 15, 2019
BREAKING: Feds kick healthcare hornet’s nest with twin rules pledging price transparency
The announcement covers OPPS, ASC regulations, and promises to ramp up competition among providers. In a move that sparked instant and intense reactions across the healthcare industry, the federal government on Friday introduced twin final rules it says constitute “historic steps” to increase price transparency and increase competition among the…
January 11, 2019
News Alert: Startling Misdirection in CMS TKA Memo
Issues abound in the newest edition of MLN Matters Most of us started our day this past Tuesday by finding the newest edition of the Centers for Medicare & Medicaid Services (CMS) MLN Matters (No. SE19002) in our email inbox. Titled “Total Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only…
October 25, 2018
Provider-Based Clinics Can Expect Major Changes
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…
July 25, 2018
News Alert: CMS Releases the 2019 OPPS Proposed Rule
As expected, the Centers for Medicare & Medicaid Services (CMS) posted the 2019 Outpatient Prospective Payment System (OPPS) proposed rule online on Wednesday. And, also as expected, the document weighed in at more than 750 pages. RACmonitor contributor Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will report…
April 26, 2018
Reconsidering the 2018 TKA Final Rule: Part I
I am changing my interpretation of the final rule with help from the trenches. Often referred to as the “carpenters” of medicine, orthopedic surgeons are not well-known for deep contemplation of Centers for Medicare & Medicaid Services (CMS) rules. But I’ll be damned if I haven’t had to wrestle with…
November 9, 2017
2018 OPPS: A Smorgasbord of Changes
The OPPS Final Rule encompasses a wide variety of subjects while providing a roadmap of issues CMS will be monitoring in 2018. The examination copy of the Outpatient Prospective Payment System (OPPS) update in the latest edition of the Federal Register is 1,133 pages long! This will translate into about…
November 2, 2017
NEWS ALERT: Total Knee Replacement Removed from Inpatient-Only List
The action by CMS to remove total knee replacement from the inpatient-only was not unexpected in the 2018 OPPS final rule released on Wednesday. In a surprised move the Centers for Medicare and Medicaid Services (CMS) released the Outpatient Prospective Payment System (OPPS) final rule Wednesday rather than on Friday…
September 7, 2017
Warning: Hospital Cardiac Service Line and Revenue at Risk
When hospital executives are asked about their specialty programs, both in terms of reputation and profitability, orthopedics and cardiology are often on the top of the list. But that may soon be changing. A great deal of attention has been paid to the proposal by the Centers for Medicare &…
The 2018 Outpatient Prospective Payment System (OPPS) proposed rule arrived Friday from the Centers for Medicare & Medicaid Services (CMS), coming in at 664 pages, which is not very long, based on history. Keep in mind that it is double-spaced, and the first 57 pages consist of the table of…
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