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2025 IPPS Proposed Rule: Additional Reporting Programs

Over the last two weeks, we have presented our readers a summary of provisions found in the FY 2025 Medicare Inpatient Prospective Payment System (IPPS) proposed rule. Last week, we introduced some of the quality programs. Today’s article takes a look at additional reporting programs that hospital administrators will need to consider. Hospital Readmissions Reduction […]

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2025 IPPS Proposed Rule: Highlights for Hospitals

On April 10, 2024, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2025 Medicare hospital inpatient prospective payment system (IPPS) proposed rule. While these provisions are not final, they do give current insight into the agency’s thinking in terms of a host of issues concerning the inpatient hospital setting, including […]

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Medicare Advantage and Part D: CMS Issues Final Rule

We recently brought an alert dealing with allegations against Medicare Advantage (MA) to the effect that MA plans were more prone to deny claims or delay payments when compared to Medicare or third-party payers. Medicare Advantage is back in the news—but, this time, for another reason. Last week, the Centers for Medicare and Medicaid Services […]

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Fading Away: Anesthesia for Chronic Pain

It was one of those end-of-an-era moments. Standing in the well of the House, before a joint session of Congress, was the “American Caesar,” General Douglas McArthur, bidding farewell to the nation after 52 years of service. First in his class at West Point, winner of the Congressional Medal of Honor and Military Governor of […]

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Taking Advantage: Sending a Message to Medicare Advantage

We’re supposed to play by the rules but not everybody does. That’s especially disappointing when that person works for the government. Recently, a former state insurance commissioner pleaded guilty to healthcare fraud. How ironic—the very person entrusted with safeguarding the consumer against insurance fraud goes on to engage in a $2.5 million scheme involving false […]

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Impact of Improved PFS Conversion Factors

Last week, we sent out a special alert, which included news that the U.S. Congress had essentially halved the Medicare Physician Fee Schedule (PFS) conversion factor reduction for 2024, meaning there should be more money coming your way in Medicare payments than previously expected for this year. For your Medicare EOBs for services performed on […]

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Getting Paid for Someone Else’s Work: The Hidden Hurdles of Incident-To Billing

It’s not an unknown phenomenon. Getting paid for something that was at least partially performed or created by someone else is a well-established practice. Thomas Edison was well known for taking the inventions of others, including his employees, and appropriating them as his own, receiving the acclaim and a hefty pay day (Nikola Tesla was […]

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Are you being underpaid by medicare advantage organizations?

What’s the Problem? Sequestration underpayments have been improperly withheld from provider payments by many Medicare Advantage Organizations [MAO] in violation of CMS guidelines that were issued on May 1, 2013.

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CMS looking to define enforcement for its hospital price transparency rule

Now that hospitals are required to post chargemaster data online for patients to access, the Centers for Medicare & Medicaid Services is exploring the most effective ways to make sure providers comply with the rules.

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