Michelle Stein

Dec 22, 2023 | insidehealthpolicy.com | Michelle Stein

The Medical Group Management Association is warning of “administrative turmoil” if Congress looks to retroactively alleviate physician fee schedule conversion factor cuts after CMS has already started processing 2024 claims, but Congress recessed this week without tackling the cuts, leaving a retroactive fix a possibility if a health care package comes together in January.

Dec 21, 2023 | insidehealthpolicy.com | Michelle Stein

CMS on Thursday (Dec. 21) unveiled a retrospective appeals process for beneficiaries who had inpatient hospital stays changed to outpatient observation status from 2009 onwards, and an expedited appeals process for beneficiaries who continue to face a change in their hospital status. The agency says that once a final rule on the procedures for these new appeals is finalized, CMS will specify the implementation date for filing appeal requests for retrospective and prospective appeals.

Dec 19, 2023 | insidehealthpolicy.com | Michelle Stein

The American Medical Association wants lawmakers to use a transfer of about $1.8 billion into the Medicare Improvement Fund -- a funding shift tucked into the defense authorization bill -- to avert upcoming Medicare physician pay cuts. The National Defense Authorization Act shifted the money from the Medicare Trust Fund into the Medicare Improvement fund, according to a Congressional Budget Office rundown of the legislation.

Dec 15, 2023 | insidehealthpolicy.com | Michelle Stein

The federal independent dispute resolution portal created by the surprise billing law began accepting batched disputes on Dec. 15 after being shut since Aug.3, and CMS has also granted parties additional time to initiate a new dispute or address existing cases.

Dec 13, 2023 | insidehealthpolicy.com | Michelle Stein

CMS’ national health spending report for 2022 found Medicaid spending overall increased 9.6% to almost $806 billion that year -- the third consecutive year of growth above 9% -- with the increase in the federal portion attributable to both the 6.2% pandemic pay bump and rapid Medicaid enrollment. But the subsequent unwinding after the end of the COVID-19 public health emergency has seen millions drop off the Medicaid roles. The federal portion of Medicaid payments in 2022 accounted for the...