Insights

Medicare Premiums, Deductibles & Coinsurance Increase For 2022

The Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income-related monthly adjustment amounts. ...

CMS Announces Extreme and Uncontrollable Circumstances Policy To Individual MIPS Eligible Clinicians

Due to the 2019 coronavirus pandemic public health emergency, the Centers for Medicare & Medicaid Services (CMS) is applying the automatic extreme and uncontrollable circumstances (EUC) policy to all individual MIPS eligible clinicians for the 2021 MIPS performance year. The ...

Home Health Payment System Final Rule For Calendar Year 2022

The Centers for Medicare & Medicaid Services (CMS) issued a rule that finalizes a nationwide expansion of the successful Home Health Value-Based Purchasing (HHVBP) Model and makes updates to the Medicare Home Health Prospective Payment System (PPS) and the home ...

Medicare Physician Fee Schedule Final Rule For Calendar Year 2022

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. ...

CMS Releases Billing Codes for J&J and Moderna Boosters

The Centers for Medicare & Medicaid Services (CMS) released Medicare Part B billing codes and payment allowances for reporting and administering single booster doses of Johnson & Johnson and Moderna COVID-19 vaccines to eligible adults as authorized by the Food and Drug Administration ...

CMS Issues Guidance On Required Medicaid & CHIP COVID-19 Coverage

The Centers for Medicare & Medicaid Services (CMS) issued guidance on Medicaid and Children’s Health Insurance Program (CHIP) coverage of COVID-19-related treatment under the American Rescue Plan Act of 2021 (ARP). ...

AMA Announces CPT Codes for Pfizer’s Pediatric COVID-19 Doses

The American Medical Association (AMA) issued new Current Procedural Terminology (CPT) vaccine and administration codes for pediatric doses of the COVID-19 vaccine developed by Pfizer. The provisional codes will be effective for use if Pfizer’s two-dose COVID-19 vaccine for children ...

GAO Reports On Provider Performance And Experiences Under MIPS

The Centers for Medicare & Medicaid Services (CMS) administers the Merit-based Incentive Payment System (MIPS), under which MIPS-eligible providers receive a “final score” based on their performance on four measures (quality, cost, promoting interoperability and improvement activities). Their score is ...

CMS Releases Surprise Billing Interim Final Rule Part II Regulations

On September 30, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), released an interim final rule with comment ...

CMS Releases 2022 Medicare Advantage and Prescription Drug Plans Information

The Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans in advance of the annual Medicare Open Enrollment to help Medicare enrollees decide on ...

CMS Will Pay For Beneficiaries’ COVID-19 Booster Shots

Following the Food and Drug Administration’s (FDA) recent action that authorized a booster shot of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & ...

CMS Issues Additional Instructions For Submitting Home Health Notices Of Admission (NOAs)

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12424, which updates chapter 10 of the Medicare Claims Processing Manual to include additional instructions for submitting home health Notices of Admission (NOAs). ...

Influenza Vaccine Payment Allowances For 2021-2022 Season

The Medicare Part B payment allowance limits for seasonal influenza (flu) vaccines are 95% of the Average Wholesale Price (AWP), except when the vaccine is given in a hospital outpatient department, rural health clinic (RHC) or federally qualified health center ...

CMS To Reprocess Certain Claims For Outpatient Clinic Visit Services

By November 1, 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin reprocessing claims for outpatient clinic visit services provided at excepted off-campus Provider-Based Departments (PBDs) so they’re paid at the same rate as non-excepted off-campus PBDs ...

AMA Releases 2022 CPT Code Set

The American Medical Association (AMA) released updates to the Current Procedural Terminology (CPT) code set for 2022. The new code set aims to streamline reporting and tracking of COVID-19 reporting, among other updates. ...

CMS Expands Medicare Payments for At-Home COVID-19 Vaccinations

In an effort to increase access to COVID-19 vaccinations, the Centers for Medicare & Medicaid Services (CMS) is expanding opportunities for people to receive vaccinations at home. Healthcare providers can now receive additional payments for administering vaccines to multiple residents ...

Medicare Reimbursement Announced For Third Dose Of COVID-19 Vaccine For Immunocompromised Individuals

The U.S. Food and Drug Administration (FDA) amended the emergency use authorizations for both the Pfizer-BioNTech and the Moderna COVID-19 vaccines to allow for the use of an additional dose in certain immunocompromised individuals, especially solid organ transplant recipients or ...

Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System For Fiscal Year 2022

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The rule revises the Medicare IPPS ...

Inpatient Psychiatric Facility Prospective Payment System Final Rule For Fiscal Year 2022

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that updates Medicare payment policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for Fiscal Year (FY) 2022 and finalizes changes to the ...

Inpatient Rehabilitation Facility Prospective Payment System Final Rule For Fiscal Year 2022

The Centers for Medicare & Medicaid Services (CMS) has issued a fiscal year (FY) 2022 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule, which updates Medicare payment policies and rates for IRFs, finalizes policies under the IRF Quality ...

Hospice Payment Rate Update Final Rule For Fiscal Year 2022

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2022, in accordance with existing statutory and regulatory requirements. This rule rebases the hospice ...

Skilled Nursing Facility Prospective Payment System Final Rule For Fiscal Year 2022

According to the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNFs) Prospective Payment System (PPS) final rule for Fiscal Year (FY) 2022, SNFs will see an increase in Medicare Part A payments of approximately $410 million in ...
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