No Congressional Doc Fix on the Immediate Horizon: What Happens Next?
Congress is on its way to extending the stop-gap funding bills into March (and may have already done so by the time you read this). Absent from the legislation to continue funding the federal...
View ArticleDid You Know Medicare Implemented New Provider and Supplier Enrollment...
The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. CMS...
View ArticleCongressional Action on Physician Fee Cut Up in the Air
In November 2023, the Centers for Medicare and Medicaid Services released the Calendar Year 2024 Medicare Physician Fee Schedule Final Rule, which reduced reimbursement for physician fee services by...
View ArticlePresident Biden Releases FY 2025 Budget: What’s NOT in It?
Earlier this week, President Biden released his Fiscal Year (FY) 2025 President’s Budget. As a reminder, every year, the White House releases a budget that serves as its official funding request to...
View ArticleOptum Seeks Massive Clawback of Medicare Advantage Plan Payments
Recently, Optum Behavioral Health (“Optum,” the services division for UnitedHealth Group) has initiated overpayment recovery actions against numerous licensed clinical social workers (“LCSWs”) across...
View Article2022 Quality Payment Program Performance Report Released: Observations and...
A couple of weeks ago, the Centers for Medicare & Medicaid Services (CMS) released an important report that provides insight into a significant contributor of clinicians’ overall Medicare...
View Article“Reg Season” is Coming! Preview of the Physician Fee Schedule
School is out and it is summertime, which means only one thing in the health policy community: reg season! This is the time of the year when the Centers for Medicare & Medicaid Services (CMS)...
View ArticleHolland & Knight Health Dose: June 25, 2024
Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector....By:...
View ArticleMedicare Proposed 2025 Telehealth Changes
CMS proposed several telehealth changes in the 2025 Medicare Physician Fee Schedule Proposed Rule, issued July 10, 2024....By: Tucker Arensberg, P.C.
View ArticleMedicare Proposes 2.8% Physician Fee Schedule Reduction
See below for the CMS (Centers for Medicare & Medicaid Services) Announcement on July 10, 2024 proposing a reduction in the Medicare Conversion Factor payment from $33.29 to $32.36, i.e. 2.8%...By:...
View ArticleMcDermottPlus Check-Up: July 12, 2024
Senate HELP Committee Holds Hearing on Medical Debt. The hearing examined the negative impacts of medical debt and explored potential solutions to address the growing issue. Senators and witnesses...
View ArticleCMS Releases Annual Medicare Hospital OPPS and ASC Payment System Proposed Rule
On July 10, the Centers for Medicare and Medicaid Services (CMS) released its annual Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed...
View ArticleCMS Releases CY 2025 Physician Fee Schedule Proposed Rule
On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to...
View ArticleThe Budget Neutrality Paradox: Explaining the CY 2025 PFS Positive Budget...
The major calendar year proposed regs are now out, with thousands of pages of text to digest. Since a plethora of issues are embedded in these regs, including the Calendar Year (CY) 2025 Physician Fee...
View ArticleThe 2025 Proposed Hospital Outpatient Prospective Payment System and...
Pharma’s favorite summer pastime is back again: reviewing the Centers for Medicare & Medicaid Services (CMS) release of the 2025 proposed Hospital Outpatient Prospective Payment System (HOPPS) and...
View ArticleCMS Issues CY 2025 Physician Fee Schedule Proposed Rule
On July 10, 2024, CMS issued a proposed rule that identifies and seeks public comments on a broad array of proposed changes to the Medicare Physician Fee Schedule (PFS) and Medicare Part B payments...
View ArticleWashington Healthcare Update - July 2024 #3
This Week in Washington: House Rules Committee to consider FY2025 Agriculture-FDA and Related Agencies funding bill amendments; MedPAC releases July 2024 data book on Medicare program spending;...
View ArticlePhysicians Face Proposed Medicare Reimbursement Cuts for 2025 (RIN 0938-AV33)
Physician Fee Schedule Faces Cuts in CY25 - Overall Medicare payments to physicians and clinicians would be cut by a proposal to decrease average base payment rates by 2.93% from calendar year 2024...
View ArticlePhysician Fee Schedule Proposed Rule Proposes New Quality-Driven Payment...
Within its proposed CY 2025 Physician Fee Schedule (PFS) rule (the Proposed Rule), CMS is proposing to implement new payment policies intended to advance health equity and support whole-person care....
View ArticleCMS Sneaks 340B Billing Proposals into Medicare Physician Fee Schedule: What...
On July 10, the Centers for Medicare & Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, which includes proposals related to identification of Medicare...
View ArticleCMS Proposes New CoP for Obstetrical Services: With Great Power Comes Great...
In case you need a reminder given everything going on in Washington, DC, the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) and CY 2025 Outpatient Prospective Payment System (OPPS) proposed regs...
View ArticleCMS Proposes Additional Revisions to the 60-Day Rule
The Centers for Medicare & Medicaid Services has issued its Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule, scheduled for publication in the Federal Register on July 31, 2024. In...
View ArticleCMS Releases CY 2025 Medicare Physician Fee Schedule Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (MPFS) and Other Revisions to Medicare...
View ArticleSubstance Use Disorder Treatment Services: 2025 Physician Fee Schedule...
On July 10, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Proposed Rule (Proposed Rule) for the calendar year 2025. The Proposed Rule would...
View ArticleCMS Proposes Extending COVID-Era Telehealth and Supervision Flexibilities...
The Centers for Medicare & Medicaid Services (CMS) proposed to extend a number of COVID-era regulatory flexibilities related to telehealth, remote services, and supervision in the CY 2025 Medicare...
View ArticleCMS Updates Master List for DMEPOS
The Master List for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) comes from a November 2019 final rule that created the list to serve as a library of items that have been...
View ArticleLegislative Uncertainty Slows Down, But Doesn’t Halt, Regulatory Action on...
Legislative Uncertainty on Telehealth Waivers Slows Down, But Doesn’t Halt, Regulatory Action on Virtual Care McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by...
View ArticleCMS Proposes Additional Modifications to the Overpayment Rule Relating to the...
In the context of Medicare Advantage (“MA”) reform initiatives, we previously addressed the Centers for Medicare & Medicaid Services’ (“CMS”) December 27, 2022 proposal to amend its regulations set...
View ArticleCMS Solicits Comments to Clarify Parameters on MAC Downcoding of Complex Drug...
In the proposed CY 2025 Physician Fee Schedule (PFS) published in the Federal Register on July 31, the Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposal to revise...
View ArticleCMS Proposes Significant Changes to the Medicare Shared Savings Program and...
Under the CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposes several modifications to the Medicare Shared Savings Program (MSSP) that would become effective in performance year...
View ArticleProposed Medicare Physician Fee Schedule Would Extend Telehealth...
The Centers for Medicare & Medicaid Services (CMS) released its annual proposed rule updating the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2025....By: Manatt, Phelps &...
View ArticleDialysis & Nephrology Digest - August 2024
As value-based care (VBC) models continue to grow across our nation’s health system and specifically within different specialties like nephrology, the costs and challenges of maintaining these models...
View ArticleAffordable Care Act Overpayments in the CY 2025 Medicare Physician Fee...
Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and...
View ArticleCMS Rules Propose Changes Regarding the Medicare Prescription Drug Inflation...
On July 31, the Centers for Medicare and Medicaid Services (“CMS”) published its mammoth proposed rule entitled “Medicare and Medicaid Programs: Calendar Year 2025 Payment Policies under the Physician...
View ArticleCMS Revives, Expands Proposed Changes to Medicare Overpayment Rule
In response to comments on the 2022 proposed changes to the overpayments regulation, the Centers for Medicare & Medicaid Services (CMS) proposed additional changes to the overpayment rule to...
View ArticleKey Telehealth Updates in the CY 2025 Physician Fee Schedule Proposed Rule
On July 31, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (“Proposed Rule”) for the 2025 Medicare Physician Fee Schedule, which includes implications for...
View ArticleResponses to the PFS Proposed Reg Are In: 10 Major Comments
McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. Click here to subscribe to future blog posts. September 19, 2024 – Comments on the calendar year...
View ArticleNew Rule Curbs Impact of Suspect DME Claims on 2023 MSSP Financial Calculations
Effective October 15, a new Final Rule issued by the Centers for Medicare & Medicaid Services (CMS) will allow the Medicare Shared Savings Program (MSSP) to adjust calendar year (CY) 2023 benchmark...
View ArticleHospital and Health Systems Reimbursement Check - NOVEMBER 2024
Ropes & Gray attorneys share their analysis of administrative and court litigation, regulatory developments, key developments affecting federal program payments to hospitals and health systems, and...
View ArticleMedicare Overpayments: CMS Issues Final Regulations Implementing Changes to...
On Friday, November 1, 2024, the Center for Medicare & Medicaid Services (CMS) issued the display copy of the final rule interpreting the 60-day Refund Rule for Medicare Parts A/B (Traditional...
View ArticlePhysician Fee Schedule Payment System Data Dashboard
Have Medicare physician fee-for-service payment rates increased for X-ray services? How have remote patient monitoring prices evolved over the last five years? How much is your service paid in Alaska...
View ArticleCMS Releases CY 2025 Physician Fee Schedule Final Rule
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions...
View ArticleDigesting the Huge Buffet of CMS Regs: Highlights from the CY 2025 PFS Final Reg
While we all are focused on the election results, let’s take a quick break to digest some regs and eggs. The Centers for Medicare & Medicaid Services (CMS) “spoiled” all of us in the health policy...
View ArticleFederal Regulatory Update: CMS Medicare Payment Changes & Congressional Next...
The Centers for Medicare & Medicaid Services (CMS) have released significant updates affecting Medicare payments for 2025. The changes, outlined in two final rules, will impact both physicians and...
View ArticleMcDermott+ Check-Up: November 8, 2024
Republicans Win Control of White House and Senate, Seem Poised to Maintain Control of House. Former President Donald Trump will return to the White House, and Republicans also gained control of the...
View ArticleMedicare Decreases Physician Fee Schedule by 2.93%
The final Medicare Physician Fee Schedule was issued on November 1st for calendar year 2025. Attached is a link to both the Press Release describing all of the Medicare changes and the link to the...
View ArticleCMS Extends Remote Direct Supervision Flexibilities in CY 2025 Physician Fee...
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year 2025 final rule for services reimbursed under the Medicare physician fee schedule. Among other...
View ArticleFinal Medicare Overpayment Rules a Mixed Bag for Providers
The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the...
View ArticleAnother Trip to the Buffet: Highlights from the CY 2025 OPPS Final Reg
As mentioned last week, the Centers for Medicare & Medicaid Services (CMS) recently put out a large buffet of regs – too many to digest in one blog post. While we focused on the Calendar Year (CY)...
View ArticleCMS Releases CY 2025 Medicare Physician Fee Schedule Final Rule
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2024, released the calendar year (CY) 2025 Revisions to Payment Policies under the Physician Fee Schedule (MPFS) and Other Revisions to...
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