CMS Finalizes Rule to Streamline Prior Authorization
Jan. 23, 2024 ||The rule requires payers to create application programming interfaces to facilitate payer-to-provider data sharing.
view more »The rule requires payers to create application programming interfaces to facilitate payer-to-provider data sharing.
view more »The rules maintain full Medicare Part B drug payment to hospitals in the 340B Drug Pricing Program, revise site-neutral payment policies, and amend price transparency policies.
view more »The proposed rule includes provisions for Medicare reimbursement of telehealth services, quality programs, and social determinants of health data collection.
view more »The association urged CMS to adequately reimburse off-campus, provider-based departments; refine physician quality reporting; and codify a definition of essential hospitals.
view more »A proposed rule for the Medicare Physician Fee Schedule for calendar year 2023 would extend telehealth regulatory flexibility, make changes to the Medicare Shared Savings Program, and revise the Quality Payment Program.
view more »The rule adjusts the conversion factor used to determine physician payment rates and includes provisions related to appropriate use criteria, Medicare reimbursement for telehealth services, vaccine payment rates, the Quality Payment Program, and the Medicare Shared Savings Program.
view more »The Centers for Medicare & Medicaid Services in an interim final rule announced new Medicare condition of participation requirements for hospitals to report COVID-19 cases and related data to the Department of Health and Human Services.
view more »CDC revised its testing guidance to reflect six new COVID-19 symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. HHS released a Workforce Virtual Toolkit, and CMS released a State Medicaid and CHIP Telehealth Toolkit.
view more »CMS issues elective surgery guidance, telehealth toolkits, and information on quality reporting flexibility amid the COVID-19 pandemic; The Joint Commission suspends regular surveys.
view more »The final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2020 also expand access to opioid use disorder treatment and establish a prior authorization process for certain services.
view more »The updated resource library includes new fact sheets and guides for the Merit-based Incentive Payment System and Advanced Alternative Payment Models.
view more »Merit-based Incentive Payment System participants can request a targeted review of their performance feedback and final score if they find an error in their 2020 payment adjustment calculation.
view more »The calendar year 2020 proposed rule includes updates to the Quality Payment Program, a request for information on the creation of Merit-based Incentive Payment System Value Pathways, and other topics of interest to essential hospitals.
view more »The recently released 2017 Quality Payment Program Experience Report includes participation and performance statistics for the Merit-based Incentive Payment System and Advanced Alternative Payment Model tracks.
view more »The tool includes 2018 Qualifying Alternative Payment Model (APM) Participant and Merit-based Incentive Payment System APM status.
view more »More than 1 million eligible clinicians received a neutral or better payment adjustment in the first year of the Merit-based Incentive Payment System, one of two tracks in the Quality Payment Program.
view more »The Outpatient Prospective Payment System and Physician Fee Schedule final rules for calendar year 2019 expand damaging site-neutral payment policies and continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program.
view more »The rule includes updates to the Quality Payment Program and documentation and payment changes for evaluation and management services.
view more »The association urged the Centers for Medicare & Medicaid Services to adequately reimburse off-campus, provider-based departments and refine physician quality reporting to account for costs of care and the unique needs and patient populations served by essential hospitals.
view more »This second segment of a no-cost, online training course focuses on outpatient antibiotic stewardship and communicating with patients; participants can receive up to eight hours of continuing education credit.
view more »Bills to repeal the medical device tax and expand health savings accounts go to a House floor vote; a House committee advanced legislation that would fund the Hospital Preparedness Program at about $265 billion annually.
view more »In the rule, the Centers for Medicare & Medicaid Services continues a policy of reduced payments to new off-campus provider-based departments; the agency also provides updates to the Quality Payment Program.
view more »The project would waive Merit-based Incentive Payment System requirements for clinicians who participate in certain Medicare Advantage plans that involve taking on risk to better align such plans with fee-for-service Medicare.
view more »Merit-based Incentive Payment System participants can request a targeted review of their performance feedback and final score if they find an error in their 2019 payment adjustment calculation.
view more »Clinicians eligible for the Merit-based Incentive Payment System can receive Improvement Activity credit for participating in a study on quality reporting burdens; applications are due April 30.
view more »Providers who submitted data through the Quality Payment Program website can review preliminary performance feedback. Final scores and feedback will be available July 1.
view more »In its annual report to Congress, the commission also recommends curbing Medicare Advantage plan consolidation and evaluating telehealth services before including them in coverage.
view more »Group reporting through the Centers for Medicare & Medicaid Services web interface must be completed by March 16; all other Merit-based Incentive Payment System data must be submitted by March 31.
view more »The table identifies which alternative payment models (APMs) are designated as Advanced APMs under the Quality Payment Program or the Merit-based Incentive Payment System.
view more »The new system streamlines quality reporting through one portal; the data submission period runs from Jan. 2 to March 31.
view more »In response to an annual update to the Quality Payment Program, the association called for increased flexibility and risk adjustment for socioeconomic factors.
view more »Final regulations for Medicare physician payments will increase merit-based payments to account for complex patients, allow physicians to participate in virtual groups, adjust the threshold for defining low-volume practices, and make numerous other changes.
view more »The Quality Payment Program combines and replaces three separate clinician quality programs with a single system for clinicians that bill Medicare Part B.
view more »The Centers for Medicare & Medicaid Services will conduct field testing from Oct. 16 to Nov. 15 of eight episode-based cost measures for the Merit-based Incentive Payment System.
view more »Clinicians can participate in the first year of the Merit-based Incentive Payment System and avoid a negative payment adjustment if they begin collecting data by Dec. 31.
view more »Merit-based Incentive Payment System–eligible clinicians and groups may apply for hardship exceptions due to connectivity issues or extreme circumstances, such as disasters.
view more »In response to a proposed annual update to the Quality Payment Program, America’s Essential Hospitals offered recommendations related to the merit-based incentive payment system.
view more »Exceptions are available for Merit-based Incentive Payment System eligible clinicians and groups that experienced insufficient internet connectivity, uncontrollable circumstances, or other issues; applications are due Oct. 1.
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