CMS Begins Issuing Warning Notices to Hospitals for Noncompliance with Hospital Price Transparency Rule

The hospital price transparency rule took effect Jan. 1, 2021, requiring hospitals and health systems to disclose all standard charges, as defined by the Centers for Medicare & Medicaid Services (CMS) to mean privately negotiated rates with insurers, gross charges (a.k.a., “list prices”) and discounted cash prices. Hospitals also are required to provide a patient price estimator tool or negotiated rate information on 300+ “shoppable” services for patients.

Posted 5/04/21 (Tue) read more »

HHS Launches New Reimbursement Program for COVID-19 Vaccine Administration Fees not Covered by Insurance

The US Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) is announcing a new program covering costs of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. Since providers cannot bill

Posted 5/04/21 (Tue) read more »

CMS Lifts Suspension of Hospital Survey Activities

The Centers for Medicare and Medicaid Services (CMS) announced the immediate resumption of survey activities for all complaints. On Jan. 20, 2021, CMS issued guidance limiting hospital surveys for all complaints

Posted 3/29/21 (Mon) read more »

2021 Special Enrollment Period Access Extended for Marketplace Coverage

The U.S. Department of Health and Human Services released 2021 Special Enrollment Period Access Extended to August 15th on for Market Place Coverage

Posted 3/24/21 (Wed) read more »

ASC Payment System Update Effective January 1, 2021

On December 27, 2020, the Consolidated Appropriations Act modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS), providing a 3.75 percent increase in MPFS payments. CMS recalculated Ambulatory Surgical Center (ASC) rates for office-based covered surgical procedures and certain covered ancillary radiology services and diagnostic tests, as well as the budget neutrality adjustment applied to all ASC procedure payment rates. We also incorporated

Posted 1/18/21 (Mon) read more »

HHS Announces Provider Relief Fund Reporting Update

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced on January 15, 2021 that it will be amending the reporting timeline for the Provider Relief Fund Program (PRF) due to the recent passage of the Coronavirus Response and Relief Supplemental Appropriations Act. HHS has been working to provide updated reporting requirements that comply with this recently passed legislation. Consequently, PRF recipients will now be required to submit their reporting requirements on their use of these funds later than previously announced.

Posted 1/18/21 (Mon) read more »

Payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments

By July 1, 2021, Center for Medicaid and Medicare Services (CMS) will begin reprocessing claims for outpatient clinic visit services provided at excepted off-campus Provider-Based Departments (PBDs) so they are paid at the same rate as non-excepted off-campus PBDs for those services under the Physician Fee Schedule (PFS). This affects claims with dates of service between January 1 and December 31, 2019. You do not need to do anything. Background:

Posted 1/18/21 (Mon) read more »

HHS Releases Advisory Opinion Clarifying that 340B Discounts Apply to Contract Pharmacies

The U.S. Department of Health and Human Services (HHS) Office of the General Counsel released an advisory opinion

Posted 1/13/21 (Wed) read more »

ND Launches New Statewide Toll-free Child Abuse & Neglect Reporting Line

Posted 1/04/21 (Mon) read more »

Telehealth Services Expanded

December 1, 2020 CMS released the annual Physician Fee Schedule (PFS) final rule,

Posted 12/02/20 (Wed) read more »