On July 18, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a payment model that would make prospective episode payments to hospital outpatient departments (HOPD) and freestanding radiation therapy centers for radiation therapy (RT) episodes of care. The model will be mandatory for a sample of RT providers and suppliers and is specific to core-based statistical area (CBSAs), which have not yet been determined. Medicare would pay participating providers and suppliers a site-neutral, episode-based payment for a list of specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. This blog is the first in the multi-series of blogs titled "Radiation Oncology Episodes of Care" and takes a look the historical Medicare payments for radiation therapy.
The Center for Medicare and Medicaid Services (CMS) recently proposed changes in the way Medicare payments for inpatient hospital visits are made through changing wage index calculations. In the proposed 2019 notice of public rulemaking (NPRM), CMS proposes two solutions to address th Medicare national standardized payments to account for differences in market area labor costs across the country. This blog discusses the implications of the NPRM for hospitals in rural areas.
Last August CMS provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes are not held accountable for those episodes, meaning that any losses incurred relative to the established target prices will not be charged to the bundler.
The Medicare Shared Savings Program (MSSP) is undergoing a major overhaul under the Pathways to Success regulation, finalized December 31, 2018. This regulation replaces the existing program participation tracks with an emphasis on increasing downside risk, as well as updates a variety of other program rules. This rule went into effect on January 1, 2019, with most aspects to be implemented fully starting July 1, 2019.
The Patient Protection and Affordable Care Act (P.L. 111-148 as amended) required significant reductions to Medicaid payments to hospitals that serve a disproportionate share (DSH) of low-income and vulnerable patients starting in 2014. However, the start of Medicaid DSH payment cuts was delayed several times by policymakers. In 2013, Congress postponed the beginning of payment reductions to 2018, and budget bills in later years continued to postpone the cuts.
Last August the Centers for Medicare and Medicaid Services (CMS) provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes will not be held accountable for those episodes. Meaning that any losses incurred relative to the established target prices will not be charged to the bundler.
Medicaid DSH provider payments are an important public policy issue as we move through “repeal and replace.” Let me tell you why.
The BPCI Advanced program is scheduled to begin on October 1, 2018. Initially, hospital and physician group practice applicants were to make a decision by August 1, 2018 as to whether to participate in the program and to select clinical episode ...
Dobson | DaVanzo staff recently completed analyses to support provider comments to CMS on proposed changes to the Inpatient Rehabilitation Facility (IRF) Prospective Payment System case-mix system. The proposed changes would primarily replace ...
The BPCI Advanced data provided to applicants by CMS these past several weeks consists of target price workbooks, an episode-level summary data file, and Medicare claims data files by service type (hospital inpatient, hospital outpatient, HHA, SNF, ...