Updates

2025 Physician Fee Schedule

CMS Releases the 2025 Proposed Medicare Physician Fee Schedule

CMS has released the 2025 Proposed Medicare Physician Fee Schedule.  The proposal contains many significant coding and coverage provisions including: 2.93% payment decrease Permanent coverage of audio only encounters under telehealth when all other criteria are met Extension of the waiver of frequency limitations on subsequent hospital, nursing facility, and

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2025 OPPS Proposed Rule

CMS Releases the 2025 OPPS Proposed Rule

CMS released the 2025 OPPS and ASC Proposed Rule this morning.  The 984 page document contains a number of important proposals including: 2.6% payment increase for eligible hospitals New conditions of participation (CoPs) for obstetrical services Updates to the Intensive Outpatient (IOP) and Partial Hospitalization (PHP) programs Separate payment for

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Audit

OIG Issues Recommendations for Short Stay Admissions

The OIG conducted an audit to evaluate the effectiveness of Medicare program safeguards to ensure appropriate reimbursement of short stay inpatient admissions.  In general, inpatient admissions which are not expected to last at least two midnights are not considered to be appropriate.  However, an inpatient stay of less than two

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Audit

OIG Semiannual Report to Congress

The OIG has issued their Semiannual Report to Congress for the period October 1, 2023 through March 31, 2024.  The report highlights over $2.76 billion in expected investigative and audit recoveries identified during the first half of FY 2024.  The report details the OIG’s ongoing work through investigations and enforcement

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CERT

2023 Medicare Improper Payments Data

The 2023 Medicare Fee-For-Service Improper Payments Report was just released.  The report identified an estimated $31.23 billion in improper payments with a payment error rate of 7.38%. The report outlines findings related to services most frequently billed and paid in error and outlines the reasons for the errors such as

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Compliance

OIG Semiannual Report to Congress

The OIG has issued their Semiannual Report to Congress for the period April 1, 2023 through September 30, 2023.  The report highlights $3.44 billion in expected investigative and audit recoveries identified during the entirety of FY 2023. The report also details the OIG’s ongoing work through investigations and enforcement actions over the past

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