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Hospital groups will sue to stop Medicare's latest site-neutral payment change

November 5, 2018


Several health care industry groups are pushing back on CMS' plan to implement site-neutral payments in its 2019 Hospital Outpatient Prospective Payment System final rule, and the American Hospital Association and its member hospitals are planning to challenge the change in court.

CMS looks to recoup $1B from MA plans under new proposal

November 5, 2018


CMS is seeking to recoup an estimated $1 billion from Medicare Advantage insurers by 2020 through audits proposed in a rule the agency released late last month.

Judge orders HHS to clear Medicare claims appeals backlog by FY 2022

November 5, 2018


HHS under a recent federal court ruling must meet several milestones to clear the backlog of Medicare claims appeals by the end of fiscal year 2022.

Inside the 2,378-page Medicare Physician Fee Schedule final rule

November 2, 2018


CMS' Medicare Physician Fee Schedule final rule includes changes to evaluation and management visit payments, an initial 3% reduction in Medicare Part B payments for new drugs, new codes to expand providers' telehealth billing options, and more.

Inside the 1,182-page Hospital Outpatient Prospective Payment System final rule

November 2, 2018


CMS has released a final rule to update Medicare's Hospital Outpatient and Ambulatory Surgical Center Payment Systems for calendar year 2019, which contains several policy updates to address payment differences between different sites of service.

Inside the 682-page Home Health Prospective Payment System final rule

November 2, 2018


CMS this week finalized a 2.2% payment increase for home health agencies in 2019, as well as a new Medicare reimbursement process that will take effect in 2020.

It's coming: 340B rule delayed 5 times to take effect in January, HHS says

November 1, 2018


HHS says a long-delayed rule that would penalize drugmakers that deliberately overcharge providers for drugs purchased under Medicare's 340B Drug Discount Program will take effect Jan. 1, 2019.

Providers are shifting to value-based payment models, report finds

October 31, 2018


About one-third of health care payments made last year were associated with value-based models, suggesting the health care industry is steadily moving away from the traditional fee-for-service model, according to a progress report by the Health Care Payment Learning and Action Network.

Trump's plan to cut drug spending: Let Medicare Part B pay the same prices as international buyers

October 26, 2018


The Trump administration is considering testing an International Pricing Index model that would pilot three new initiatives intended to lower the prices of drugs covered under Medicare Part B.

Medicaid enrollment dropped—but spending stayed the same, survey finds

October 26, 2018


Medicaid spending in 2018 rose at the same rate as 2017, despite the program experiencing its first enrollment decline since 2007, according to Kaiser Family Foundation's annual survey of state Medicaid directors.

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