The final CY 2012 Medicare Outpatient Prospective Payment System (OPPS) final rule implemented a statutory mandate that CMS develop an exceptions process related to the ACA’s prohibition on expanding an existing physician-owned hospital’s facility capacity. The rule provided that in order to be eligible for an exception, the physician-owned hospital must satisfy eligibility criteria
Specialty Hospitals
CMS Issues Final CY 2011 HOPPS/ASC Rates
By Debra A. McCurdy on
On November 24, 2010, the Centers for Medicare & Medicaid Services (CMS) is publishing its final rule updating the Medicare hospital outpatient prospective payment system (HOPPS) and the ambulatory surgical center (ASC) payment system rates and policies for calendar year (CY) 2011. Highlights of the lengthy rule are available after the jump.
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MedPAC Report to Congress — Medicare Payment/Transparency Provisions
By Debra A. McCurdy on
On February 27, 2009, MedPAC released its March 2009 Report to the Congress: Medicare Payment Policy. The report includes a series of recommendations for Medicare payments designed to assure beneficiaries’ access to care and preserve Medicare’s long-term sustainability, particularly through reductions in payment updates for 2010. The report also includes recommendations to increase transparency of physician financial relationships. A listing of key recommendations follows after the jump.
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Medicaid Regulations Moratoria/Physician Ownership Restrictions Advance
By Debra A. McCurdy on
On May 22, 2008, the Senate approved a version of the fiscal year (FY) 2008 emergency supplemental appropriations bill, H.R. 2642. The Senate bill would extend a current moratorium on implementation of certain Medicaid regulations and block additional rules through April 1, 2009. The rules affected by the legislation involve: payments to public safety net institutions; coverage …
OIG Reports
By Debra A. McCurdy on
The OIG has issued a report on Medicare Part D payments to community pharmacies. Among other things, the OIG found that Medicare Part D payments (excluding dispensing fees) exceeded the pharmacies’ drug acquisition costs by about 18.1 percent when drug wholesalers rebates to pharmacies were included. Excluding rebates, Part D payments exceeded drug acquisition costs …