Archives: Other CMS Developments

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CMS Wants Input on Role of Out-of-State Medicaid Providers in Coordinating Care for Children with Medically Complex Conditions

The Centers for Medicare & Medicaid Services (CMS) has released a Request for Information (RFI) on how the Medicaid program can incorporate out-of-state providers in coordinating care for children with certain medically complex conditions under Medicaid.  The RFI is intended to help CMS implement a provision of the Medicaid Services Investment and Accountability Act of … Continue Reading

CMS Requests Ideas for Easing Medicare Supervision/Scope of Practice Requirements

The Centers for Medicare & Medicaid Services (CMS) is inviting suggestions for how it can eliminate Medicare regulations that (1) impose more stringent supervision requirements than existing state scope of practice laws, or (2) restrict health professionals from practicing at the top of their license.  This comment solicitation, which is part of the Administration’s “Patients … Continue Reading

CMS is Tracking Down Clinicians Owed Medicare Advanced Alternative Payment Model (APM) Incentive Payments

The Centers for Medicare & Medicaid Services (CMS) has issued a “payment advisory” alerting approximately 1,400 clinicians who are Qualifying APM participants based on their 2017 performance that CMS does not have the participants’ banking information.  This banking information is necessary for CMS to disburse their 5% Advanced APM Incentive Payments for 2019.  The advisory … Continue Reading

CMS Posts Final 2020 Medicare Clinical Lab Fee Schedule Rates

The Centers for Medicare & Medicaid Services (CMS) has posted the final Medicare clinical laboratory fee schedule (CLFS) rates for 2020.  The files reflect updates announced in a December 13, 2019 CMS transmittal, which also discusses payment policies for new CLFS codes effective January 1, 2020. As reported previously, the final fiscal year 2020 consolidated … Continue Reading

CMS Announces 2020 Medicare DMEPOS Rates

The Centers for Medicare & Medicaid Services (CMS) has released the 2020 Medicare fee schedule for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).  The 2020 update factor is 0.9%, although other pricing policies are applied in specific circumstances, including separate adjustments for certain DMEPOS furnished in former competitive bidding areas.   Additional details are provided … Continue Reading

CMS Plans Stakeholder Surveys to “Further Strengthen” the DMEPOS Competitive Bidding Program; Comment Opportunity through December 20, 2019

The Centers for Medicare & Medicaid Services (CMS) is seeking public input on surveys that are intended to “further strengthen the monitoring, outreach, and enforcement functions” of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program – even though the agency has asserted that the program “has maintained beneficiary access to quality … Continue Reading

CMS Announces Final 2020 HCPCS Codes

The Centers for Medicare & Medicaid Services (CMS) released its final 2020 alphanumeric Healthcare Common Procedure Coding System (HCPCS) update. The file includes HCPCS procedure and modifier codes, their long and short descriptions, and associated information on Medicare coverage and pricing.  CMS also has summarized its final determinations regarding HCPCS applications discussed at its 2019 … Continue Reading

CMS Posts Preliminary 2020 Medicare Clinical Lab Payment Determinations

Preliminary 2020 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes are now available for review.  For each code, the Centers for Medicare & Medicaid Services (CMS) announces whether it intends to use crosswalking or gapfilling to establish the payment rate, along with the agency’s rationale for its … Continue Reading

Trump Administration Launches Multi-Pronged Effort to “Transform Care Delivery for Patients with Chronic Kidney Disease”

The Trump Administration has announced a number of policy goals and innovation models that seek to “improve the lives of Americans suffering from kidney disease, expand options for American patients, and reduce healthcare costs,” according to the Department of Health and Human Services (HHS).  The broad policy framework was outlined in an executive order on … Continue Reading

CMS Accelerates Investigations of EMTALA Complaints, Surveys of Hospital Deaths in Restraint or Seclusion

The Centers for Medicare & Medicaid Services (CMS) has instructed state survey agencies that they must conduct onsite complaint investigations related to Emergency Medical Treatment and Labor Act (EMTALA) complaints and surveys of death in restraint or seclusion in hospitals and critical access hospitals within two business days instead of five.  This change brings these … Continue Reading

CMS Details Bidding Timeline for Round 2021 of the DMEPOS Competitive Bidding Program

Medical equipment suppliers can submit bids for Round 2021 of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) from July 16 through September 18, 2019, the Centers for Medicare & Medicaid Services (CMS) has just announced. As previously reported, Round 2021 of the CBP round will cover 16 product … Continue Reading

CMS Rolls Out New Policies to Promote Medicare Beneficiary Access to Emerging Technologies

Agency Promises More Frequent Drug/Device HCPCS Code Update Opportunities, Bars MACs from Adopting New Blanket Noncoverage Policies without Evidence Review   On May 2, 2019, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma outlined new improvements to the HCPCS coding and local coverage decision processes that are intended to “ensure safe and effective … Continue Reading

CMS Proposes $195 Million Boost in Medicare Payments to Inpatient Rehabilitation Facilities in FY 2020

The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule to update the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS) for fiscal year (FY) 2020.  CMS projects that IRF PPS payments would rise by $195 million under the proposed rule.  Specifically, CMS proposes a 2.5% increase factor, based on an IRF … Continue Reading

CMS Announces Plans to Kick Off 2020 Medicare Clinical Lab Test Update Process

The Centers for Medicare & Medicaid Services (CMS) has scheduled a June 24, 2019 public meeting on calendar year (CY) 2020 Medicare Clinical Laboratory Fee Schedule (CLFS) payments for new or substantially revised clinical lab codes.  Specifically, the June meeting will provide an opportunity for the public to submit comments on the appropriate basis — … Continue Reading

CMS Spells Out New Standards for State Surveyors on Immediate Jeopardy Citations

The Centers for Medicare & Medicaid Services (CMS) recently revised its guidance to states on standards for citing “immediate jeopardy” during surveys of all provider and supplier types and laboratories, including health, emergency preparedness, and life safety code surveys.  CMS Administrator Seema Verma observed in a blog post that the changes were made in response … Continue Reading

CMS Announces Plans to Restart DMEPOS Competitive Bidding Program in 2021; Trump Proposed Budget Seeks Authority for Lower Payments to “Winning” Suppliers

The Centers for Medicare & Medicaid Services (CMS) has announced its plans for Round 2021 of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP), featuring new “lead item” bidding rules and new product categories.  Following on the heels of this announcement, the Trump Administration proposed additional legislative changes to … Continue Reading

Newest CMS Innovation Model Targets Medicare Payment for Emergency Ambulance Services

The Centers for Medicare & Medicaid Services (CMS) plans to test a new voluntary emergency ambulance service innovation model that seeks promote “the most appropriate level of care at the right time and place.”  In announcing the model, CMS noted that because Medicare regulations now only allow payment for emergency ground ambulance services for transportation … Continue Reading

CMS Announces Significant Expansion of and Increased Flexibility under Medicare Advantage Value-Based Insurance Design (VBID) Model

The Centers for Medicare & Medicaid Services (CMS) is making extensive revisions to its Medicare Advantage (MA) Value-Based Insurance Design model in order “to contribute to the modernization of Medicare Advantage through increasing choice, lowering cost, and improving the quality of care for Medicare beneficiaries.” By way of background, the VBID innovation model was launched … Continue Reading

New CMS Date of Service Coding and Billing Guidance Complicates Billing for Non-Global Radiology Claims

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance on what date of service (DOS) should be billed for various Medicare Part B services.  For radiology services, CMS offers the option of reporting the DOS of either the date when the radiology study was performed on the patient or the date of … Continue Reading

CMS Announces 2019 Medicare Clinical Lab Fee Schedule Rates

CMS has finally posted the Medicare clinical laboratory fee schedule (CLFS) rates for 2019, which are based on private payer data as mandated by the Protecting Access to Medicare Act of 2014 (PAMA).  The files reflect payment rate changes announced in a December 14, 2018 CMS transmittal, which also discussed policy changes including revisions to the … Continue Reading

2019 Medicare DMEPOS Fee Schedule Released

CMS has posted calendar year 2019 Medicare fee schedule rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).  The 2019 update factor is 2.3%, although other pricing policies are applied in specific circumstances.  For instance, adjusted fee schedule amounts for former competitive bidding areas are based on single payment amounts in effect December 31, … Continue Reading

CMS Tweaks HCPCS Coding Process to Promote Transparency, Ease Device Market Volume Requirement

Responding to longstanding industry criticisms, the Centers for Medicare & Medicaid Services (CMS) has announced a number of changes to the Healthcare Common Procedure Coding System (HCPCS) coding process for 2019.  Most of the new policies are intended to increase transparency regarding CMS HCPCS coding decisions.  The one substantive change of note is that CMS … Continue Reading

New Medicare Supervision Rules Applicable to both Physician Offices and Hospital Outpatient Departments

In a transmittal issued last week, the Centers for Medicare & Medicaid Services (CMS) extended newly-revised supervision rules for certain diagnostic tests paid via the Medicare Physician Fee Schedule (MPFS) to services paid under the Outpatient Prospective Payment System (OPPS) for hospital outpatient departments. The transmittal relates to services performed by a registered radiologist assistant who … Continue Reading
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