Healthcare policy is constantly evolving, and with the release of the CMS calendar year 2025 OPPS proposed rule, healthcare providers and administrators have much to consider. This comprehensive guide aims to decode the proposed changes and their potential impact on the healthcare landscape. Whether you're a provider, hospital administrator, medical coder or other healthcare professional, understanding these updates is crucial for staying ahead.  Understanding the CMS CY 2025 OPPS proposed rule  On July 10, the Centers for Medicare & Medicaid Services (CMS) released the proposed CY 2025 payment rule for the Medicare outpatient prospective payment system (OPPS). This yearly update includes modifications that affect Medicare fee-for-service outpatient payment rates and introduces new policies aimed at improving healthcare delivery.  Key changes in the proposed rule  The proposed rule encompasses several notable changes, including the addition of services to the inpatient-only (IP

On July 10, the Centers for Medicare & Medicaid Services (CMS) released its calendar year 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule. This proposed rule is more than just a list of updates; it's a roadmap that will shape the future of ambulatory surgery centers (ASCs). Understanding these changes is crucial for ASCs looking to adapt and thrive in an evolving healthcare landscape.  In this blog post, we will explore the key proposals outlined by CMS, including adjustments in payment rate settings, additions to covered procedures and new measures for quality reporting. Our goal is to provide you with a comprehensive overview of the potential impacts on your operations, helping you make informed decisions as you prepare your comments for CMS before the Sept. 9 deadline.   Unpacking the CY 2025 ASC Proposed Rule  At the heart of the CY 2025 proposal is a series of strategic changes aimed at enhancing the

On July 31, the Centers for Medicare and Medicaid Services (CMS) released the federal fiscal year (FFY) 2025 final payment rule for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS). The significant updates made in this rule have been a long time coming, considering this payment setting has not seen substantial revisions in many years.   Let's break down what these changes mean for healthcare providers and policy analysts: Think of this as your IPF PPS fact sheet!   Understanding the adopted changes  Aligning ECT payments  One of the pivotal changes in the FFY 2025 IPF PPS final payment rule is the alignment of IPF PPS payments that include electroconvulsive therapy (ECT) payments with the increased cost of furnishing ECT. CMS analyzed the most recent outpatient PPS (OPPS) cost data to consider changes to the IPF ECT payment for FFY 2025. Based on this analysis, CMS will use the calendar year (CY) 2024 OPPS pre-scaled, pre-adjusted geometric mean cost for EC

As the healthcare field further recognizes the critical role that socioeconomic factors play in patients' well-being, it’s important that providers and healthcare institutions adopt a holistic approach that addresses SDOH.   DataGen’s Mandi Diamond, senior practice transformation advisor, breaks down the key reasons for understanding and measuring SDOH and provides additional healthcare delivery insights. Read on for expert medical practice consulting advice.   Understanding social determinants of health   In recent years, healthcare practices have been held accountable for collecting SDOH data. This metric includes race, ethnicity, language, socioeconomic barriers and even personal circumstances, like family structure and sexual orientation/gender identity.  The more practices expand their data collection efforts, the easier it is to understand patients' backgrounds. This allows practices, specialists and community resources to build stronger, more trusting relationships based

The National Committee for Quality Assurance (NCQA) consistently strives to enhance the quality of healthcare and improve patient outcomes. With the changing Patient-Centered Medical Home (PCMH) 2025 annual reporting requirements, it’s essential for healthcare professionals, providers and administrators to stay updated on the latest developments to enhance quality care and patient outcomes.  Here, DataGen’s Mandi Diamond, senior practice transformation advisor, covers the three biggest changes you need to know about for next year's annual PCMH reporting related to quality improvement worksheets, the importance of diverse patient examples in care management plans and enhanced communication protocols.    Let’s dive into the most important PCMH reporting requirement changes.   1. Re-introduction of the mini quality improvement worksheet  One significant update is the re-introduction of the mini quality improvement (QI) worksheet, which was used a few years back. This updated workshee

Compliance with Statewide Planning and Research Cooperative System (SPARCS) data submissions is crucial for hospitals and ambulatory surgery centers. With Q2 deadlines quickly approaching, facilities could face submission penalty accumulation as they meet delinquency conditions for both Q4 2023 and Q1 2024.  This blog covers the most recent compliance dates and details what to keep track of to avoid penalties and ensure timely, accurate data submissions.  Key compliance dates for SPARCS data  By adhering to these guidelines and keeping track of critical dates, your facility can maintain compliance and avoid unnecessary complications.    June 15  Third warning for Q4 2023 data   Facilities received a third warning if their Q4 2023 SPARCS data were non-compliant. This was the last opportunity to resolve any data errors before a formal Statement of Deficiency (SOD) audit was performed on July 15, 2024.  June 30  Submission deadline for Q1 2024 data   This was the deadline for submitting

Community Health Assessments (CHAs) are vital for pinpointing community health needs. Enhancing CHAs with greater collaboration, stakeholder engagement and innovation significantly boosts their effectiveness and impact. The biennial CHA process utilizes primary and secondary data to identify priority issues, which assists in developing the Community Health Implementation Plan (CHIP).   1. Engage diverse stakeholders  Inclusive partnerships are essential for addressing health needs effectively by engaging a broad spectrum of stakeholders, including community-based organizations, healthcare providers and policymakers. By involving diverse groups, you can gain a comprehensive understanding of health needs and ensure strong support for health initiatives.   The National Association of County and City Health Officials (NACCHO) emphasizes that engaging a variety of stakeholders is crucial for gathering diverse insights and securing backing for these initiatives.   Building strong partnersh