CMS

WASHINGTON, D.C. (January 4, 2016)—CMS Tuesday issued a final rule, “Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” that would establish a prior authorization process for certain DMEPOS items that they cite as frequently subject to unnecessary utilization.

WASHINGTON, D.C. (December 29, 2015)—CMS finalized the rule to implement Prior Authorization for general DMEPOS items. The final rule was published on December 29th. The proposed rule, published in May 2014, suggested that a prior authorization requirement be imposed for selected HCPCS that are frequently subject to unnecessary utilization. The originally proposed master list consisted of 139 HCPCS.

WASHINGTON, D.C. (December 15, 2015)—The Centers for Medicare & Medicaid Services (CMS) is committed to providing current quality performance data that is useful to the consumer. Recently, data was refreshed on both the Physician Compare and Hospital Compare websites to improve these consumer online tools.

One House Call Has Big Aging-In-Place Payoff
When it comes to helping seniors age in their own home, an in-home assessment from a physician or nurse practitioner goes a long way. (Tim Mullaney/Home Health Care News)

WASHINGTON, D.C. (December 2, 2015)—In 2014, per-capita health care spending grew by 4.5 percent and overall health spending grew by 5.3 percent, a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs. Those rates are below most years prior to passage of the Affordable Care Act.

WASHINGTON, D.C. (November 24, 2015)—On November 23, the Centers for Medicare & Medicaid Services (CMS) announced the release of the 2016 Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts.

WASHINGTON, D.C. (November 19, 2015)—The Centers for Medicare & Medicaid Services (CMS) released a new report today showing that consumers have received more than $2.4 billion premium rebates since 2011 because the Affordable Care Act requires that health insurance companies spend at least 80 percent of premium dollars on health care. For 2014 alone, over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family.

WASHINGTON, D.C. (November 18, 2015)—Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2014, there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations alone.

WASHINGTON, D.C. (NOVEMBER 11, 2015)—Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

WASHINGTON, D.C. (November 3, 2015)—The Centers for Medicare & Medicaid Services (CMS) released an interactive online mapping tool which shows geographic comparisons at the state, county, and ZIP code levels of de-identified Medicare Part D opioid prescription claims—prescriptions written and then submitted to be filled—within the United States.

WASHINGTON, D.C. (October 28, 2015)—The Hospital Value-Based Purchasing (VBP) Program adjusts what CMS pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they give patients.

WASHINGTON, D.C. (October 29, 2015)—Today, the Centers for Medicare & Medicaid Services (CMS) proposed to revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs.

WASHINGTON D.C. (October 30, 2015)—The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care.

Open Enrollment is just around the corner, and we’re ready to welcome consumers back to HealthCare.gov. Over the last few months, our team has been hard at work, applying lessons learned and taking steps to make enrollment quicker and smoother for both returning and new customers.

NASHVILLE (October 15, 2015)—TeamDME! announced today that Centers for Medicare/Medicaid Service (CMS) has begun returning paid ERAs for claims submitted with ICD-10 Diagnosis Codes. This confirms that clients using TeamDME! can get paid for claims with Dates-of-Service on/after Oct 1, 2015.

TeamDME! made the transition seamless by providing education on the conversion via newsletters and online webinars as well as providing tools to assist clients with the transition.

As part of the Administration’s efforts to make our healthcare system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) has posted a new data set as part of the Provider Utilization and Payment files.