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Healthcare E-Alerts Blog posts

September 13, 2023
by Christopher Martin

Opening up the Blinds: Transparency Rules for Hospitals

A few months ago, the Centers for Medicare and Medicaid Services (CMS) published a fact sheet that outlines process updates the agency is making to increase compliance with the hospital price transparency requirements. As our readers may recall, the government’s hospital price transparency requirements are authorized by section 2718(e) of the Public Health Service Act, […]

September 7, 2023
by Christopher Martin

On a Roll: Another Victory for the TMA

For the fourth time in a row, a federal judge has sided with the Texas Medical Association (TMA) in its legal challenges to regulations that implement the federal No Surprises Act (NSA).  The TMA brought another one of its legal actions back in November, alleging that certain provisions of the NSA regulations inappropriately link providers’ […]

August 30, 2023
by Christopher Martin

2024 IPPS Final Rule: Quality Programs

Over the last two weeks, we have provided the latest provisions arising from the 2024 Inpatient Prospective Payment System (IPPS) final rule released earlier this month by the Centers for Medicare and Medicaid Services (CMS). This alert will act as our final installment on the IPPS rule and will specifically focus on the CMS quality […]

August 23, 2023
by Christopher Martin

2024 IPPS Final Rule: Special Rules for Special Hospitals

There is a scene in the movie Tora, Tora, Tora where a group of sailors on a Japanese aircraft carrier excitedly gather around one of their celebrated pilots. When asked by one of the flight crew, “how did you rate another promotion,” the cocky pilot wryly remarked, “special people deserve special treatment,” which brought roars […]

August 16, 2023
by Christopher Martin

2024 IPPS Final Rule Released: What It Means for the Inpatient Hospital Setting

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published its final rule relating to payment and other policies for the inpatient hospital setting. The 2024 Inpatient Prospective Payment System (IPPS) final rule provides regulations on a wide range of issues. The following will act to summarize some of the key provisions. Payment […]

August 9, 2023
by Christopher Martin

Ghost in the Machine: Payer Programming Auto-Denies Claims?

In May of 1999, Vice President Al Gore made a startling assertion to CNN’s Wolf Blitzer: “During my service in the U.S. Congress, I took the initiative in creating the Internet.” Wow! I guess that’s why we talk in terms of computer Al-Gor-ithms to this day (cue the “bah-dah-boom” on the snare and cymbal). Of […]

August 2, 2023
by Christopher Martin

2024 OPPS Proposed Rule: Recommendations for Rural Hospitals

“Take me home, country roads, to the place I belong.” So begins the iconic chorus to one of America’s favorite tunes dedicated to rural settings and down-home living. While most of our citizens live in urbanized areas, with ready access to an array of services and conveniences, those who dwell in the hills and hollers […]

July 26, 2023
by Christopher Martin

2024 OPPS Proposed Rule: Part 2

Last week, in our initial treatment of Medicare’s recently released 2024 Outpatient Prospective Payment System (OPPS) Proposed Rule, we highlighted what the Center for Medicare and Medicaid Services (CMS) has planned for two areas: (a) payment rates, and (b) the intensive outpatient program (IOP). Today’s article will update our readers on the rest of the […]

July 19, 2023
by Christopher Martin

2024 OPPS Proposed Rule: What Hospitals Need to Know

Last week, the Centers for Medicare & Medicaid Services (CMS) published its calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule (PR), along with the ASC Payment System Proposed Rule. There is a 60-day comment period on the PR, which will end on September 11, 2023. The final rule will be issued […]

July 13, 2023
by Christopher Martin

Drug Payment Policy: A Proposed Remedy by CMS

I’m sure the mercurial Dr. Jekyll and the feverish Dr. Frankenstein felt they were operating under sound medical principles when they first began their eccentric experiments, but their research soon became bigger than the both of them. Sometimes, despite our best efforts, we end up creating a monster. That’s what happened, in a sense, with […]