Medicare reimbursement policy

Jury Still Out on Revised 2-Midnight Rule

A regulation that requires Medicare Advantage plans to comply with Medicare’s 2-midnight rule in the same manner as traditional Medicare as of 2024 is bringing mixed results for hospitals. Some hospitals report increased admissions – and inpatient revenue – as they admit Medicare patients previously kept under observation status. Others, though, report that with those increased admissions has come a reduction of case-mix index because these newly admitted patients are not as acutely ill as the typical hospital patient. Still others report no clear impact yet of the requirement that Medicare Advantage plans treat the 2-midnight rule the same as [...]

joe2024-08-21T12:30:42-04:00August 22, 2024|Medicare regulations, Medicare reimbursement policy|

MedPAC Outlines Plans for the Coming Year

The Medicare Payment Advisory Commission has shared its agenda for its 2023-2024 public meeting cycle. According to MedPAC, it will engage in its regular work of offering recommendations to Congress on the adequacy of Medicare payments to providers and, as needed, suggest changes in those payments. In addition, it will fulfill two statutory requirements in the coming year: to evaluate Medicare Advantage special needs plans for individuals eligible for both Medicare and Medicaid and to review the new “Rural Emergency Hospital” designation. In addition, MedPAC writes that We are working on several other issues in the Medicare program as well, [...]

iqtsupport2023-10-24T16:43:49-04:00October 24, 2023|Centers for Medicare & Medicaid Services, Congress, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s December agenda were: The Medicare prescription drug program (Part D) Opioids and alternatives in hospital settings: payments, incentives, and Medicare data Hospital inpatient and outpatient services payments Redesigning Medicare’s hospital quality incentive programs Physicians and other health professional services payments Medicare payment policies for advanced practice registered nurses and physician assistants Ambulatory surgical centers and hospice payments Skilled nursing facilities, home health agency, and inpatient rehabilitation facilities payments Long-term care hospital services payments Outpatient dialysis payments Future [...]

iqtsupport2019-01-24T06:00:53-05:00January 24, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, MedPAC|

MedPAC Mulls Billing Change for Nurse Practitioners, Physician Assistants

Medicare would permit nurse practitioners and physician assistants to bill directly for their services under a proposal being considered by the Medicare Payment Advisory Commission. Currently such services are billed as “incident to” physician services, but according to a report in Becker’s Hospital Review, MedPAC staff told commissioners there are problems with “incident to” billing because it “obscures policymakers’ knowledge of who is providing care for beneficiaries,” “inhibits accurate valuation of fee schedule services,” and “increases Medicare beneficiary spending.” Staff also said that physician assistants and nurse practitioners increasingly practice outside of primary care. MedPAC is an independent congressional agency [...]

iqtsupport2018-12-13T06:00:59-05:00December 13, 2018|Medicare, Medicare reimbursement policy, MedPAC|