January 29, 2020

CMS Adds Major Updates to QPP Library

To help clinicians understand how to participate in the Quality Payment Program (QPP) for 2020, the Centers for Medicare and Medicaid Services (CMS) has posted Quick Start Guides. Click on hyperlinks for immediate downloads now available: MIPS Overview Eligibility and Participation Part B Claims Reporting Quality Performance Category Promoting Interoperability Performance Category Improvement Activities Performance Category Cost Performance Category The 2020 Quality Benchmarks provides a listing of the 2020 benchmarks and explains how they are used to assess performance in the Quality performance category.  Click on this hyperlink to download the zip file 2020 Quality Benchmarks. Visit the QPP Resource Library to review new and existing QPP resources.
December 24, 2019

Congress Continues to Develop Surprise Billing Legislation

On Dec. 11, the House Ways and Means Committee issued an outline of that panel’s bipartisan proposal for addressing surprise medical bills. Some details are vague, and it could be after the holidays before we see legislative language. Nonetheless, the committee’s approach offers significant differences from the recently issued agreement reached between the House Energy & Commerce Committee and the Senate Health, Labor, Education, and Pension (HELP) Committee. Like other proposals, the Ways & Means plan would limit patients’ out-of-pocket costs to the amounts they would have owed if they had the opportunity to choose in-network physicians and facilities to provide their care. An independent dispute resolution (IDR) system is also included.  However, unlike other proposals, Ways & Means does not restrict […]
December 24, 2019

CMS Issues Proposed Rule on Medicaid Oversight

On Nov. 12, 2019, CMS released a proposed rule aimed at strengthening oversight and fiscal integrity in the Medicaid program. The proposal was published in the Federal Register on Nov. 18. The proposed rule seeks greater transparency and accountability in Medicaid fee-for-service provider payments; disproportionate share hospital payments; Medicaid program financing; supplemental payments; and health care-related taxes and provider-related donations. Comments on the proposed rule are due on Jan. 17, 2020. The last several years have seen a rapid increase in Medicaid spending from $456 billion in 2013 to an estimated $576 billion in 2016. Much of this growth came from the federal share that grew from $263 billion to an estimated $363 billion during the same period. Supplemental payments, […]
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 […]