Archive for the Financial Feature Category

CMS Proposes to Lower Drug Costs by Targeting “Backdoor Rebates” and Encouraging Direct Discounts to Patients

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would amend the safe harbor regulation concerning discounts, which are defined as certain conduct that is protected from liability under the Federal anti-kickback statute, Section 1128B(b) of the Social

Read more

Advance Notice of Methodological Changes for CY 2020 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter

CMS released proposed changes that “will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.” CMS released

Read more

CMS Releases Notice of Benefit and Payment Parameters for 2020

The Centers for Medicare & Medicaid Services issued their proposed annual Notice of Benefit and Payment Parameters for the 2020 benefit year. The proposed rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing

Read more

CMS Final ACO Rule: Extensively Restructures the Program & Transfers More Risk

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will overhaul the Medicare Shared Savings Program, which is the program established by the Affordable Care Act (ACA) and launched in 2012 under which the vast majority of Medicare’s Accountable Care Organizations

Read more

CMS Issues Proposed Rule to Lower Drug Costs

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would amend Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations “to support health and drug plans’ negotiation for lower drug prices and reduce

Read more

Final Rule for CY 2019 Hospital Outpatient and ASC Prospective Payment Systems

The Centers for Medicare and Medicaid Services (CMS) have issued a rule that updates payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and in ambulatory surgical centers (ASCs) beginning Jan. 1, 2019 (CY 2019). The

Read more

CMS Finalizes CY 2019 Revisions to Physician Fee Schedule

CMS has issued a final rule that includes update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2019 (CY 2019). The 2019 physician fee schedule conversion factor is $36.04, which

Read more

CMS Finalizes CY 2019 End-Stage Renal Disease PPS Update

CMS has issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for services furnished on or after Jan. 1, 2019 (CY 2019). This rule updates the acute kidney injury (AKI) dialysis payment rate for

Read more

CMS Finalizes Calendar Year 2019 Payments and 2020 Policy Changes for Home Health Agencies and Home Infusion Therapy Suppliers

CMS issued a final calendar year 2019 update to the home health prospective payment system (HH PPS). The rule will update both the payment rates and case-mix weights for home health agencies (HHAs) for CY 2019. For home health services beginning on or after

Read more

CMS Proposes Select Calendar Year 2020 Medicare Advantage and Part D Changes

CMS issued a proposed rule that would revise certain aspects of the Medicare Advantage (MA) program (Part C), the Prescription Drug Benefit program (Part D); implement certain provisions of the Bipartisan Budget Act of 2018; improve quality and accessibility; clarify certain program integrity

Read more

Visit Us


North Carolina Healthcare Association

2400 Weston Parkway
Cary, NC 27513
Directions

Main: 919-677-2400
Fax: 919-677-4200

Contact Us