Nikki Golden

December 1, 2019

CMS Issues Final Rule for Hospital Price Transparency

On Nov. 1, as part of the OPPS/ASC Final Rule, CMS also finalized policies on price transparency. These policies follow directives in President Trump’s Executive Order, “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” and are intended to establish a foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services. The final rule requirements would apply to each hospital operating in the United States. The rule implements Section 2718(e) of the Public Health Service Act and improves upon prior agency guidance that required hospitals […]
December 1, 2019

CMS Issues Final Rule for 2020 OPPS/ASC Payment System

On Nov. 1, CMS issued a final rule for the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. In accordance with Medicare law, CMS is updating OPPS rates for hospitals that meet applicable quality reporting requirements by 2.6 percent. This update is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment for Multi-Factor Productivity (MFP). Using the hospital market basket, CMS is finalizing an update to the ASC rates for CY 2020 equal to 2.6 percent. The update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment […]
November 30, 2019

ISASS, Other Stakeholders Respond to the White House’s Executive Order on Medicare

ISASS was a signatory to a letter to the White House in response to the White House Executive Order issued on Oct. 3. President Trump issued an Executive Order on “Protecting and Improving Medicare for our Nation’s Seniors.”  Although the Executive Order does not provide legislative or regulatory specifications, it raises policy areas that the President believes must be addressed to improve the Medicare program. The Executive Order aims to expand enrollment in Medicare Advantage (MA) plans to make them more attractive to seniors than the traditional fee-for-service program. Within one year, the Secretary of Health and Human Services is asked to propose regulations and implement other administrative actions to provide more diverse and affordable MA options for seniors, by: Encouraging innovative MA […]
November 30, 2019

CMS Issues Final Rule for 2020 Medicare Physician Fee Schedule

In addition to the proposed RVU changes for CPT 27279, the 2020 Medicare Physician Fee Rule updated several policies of relevance to ISASS members. Payment is made under the Physician Fee Schedule (PFS) for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, office visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities. Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are […]