When you partner with DataGen and use our Medicare fee-for-service policy analytics solution, you receive Medicare IPPS proposed rule payment briefs, along with additional essential Medicare fee-for-service (FFS) updates and materials throughout the year.   DataGen provides an overview of the Centers for Medicare and Medicaid Services’ (CMS) federal fiscal year (FFY) 2026 proposed rule for the Medicare Inpatient Prospective Payment System (IPPS)    Overview of policies for the FFY 2026 IPPS new proposed rule The DataGen Medicare FFS policy analytics team summarized and analyzed the following policy changes in the new proposed rule:  utilizing FFY 2024 Medicare Provider and Review (MedPAR) and FFY 2023 Hospital Cost Reporting Information System (HCRIS) data for standard calculations;  updates to the Medicare Disproportionate Share Hospital (DSH) payment policies, including hospital eligibility for DSH Uncompensated Care (UCC) payments in FFY 2026 being...

On Sept. 30, the Centers for Medicare & Medicaid Services (CMS) released the FFY 2025 IPPS Interim Final Rule with comment period (IFC) , marking a significant shift in how hospitals manage their wage index challenges. Designed to address disparities between low and high wage index hospitals, the rule modifies the federal fiscal year (FFY) 2025 hospital inpatient prospective payment system (PPS) low wage index policy.   This blog post will explore the IFC and its implications for the healthcare industry. In addition, we'll provide insights on the IPPS analysis based on the final rule — so you can best navigate these changes with the most up-to-date adoptions.  Key changes in the FFY 2025 IPPS Interim Final Rule  The FFY 2025 IPPS IFC brings several critical changes to the existing structure of hospital reimbursements under Medicare. Initially implemented in FFY 2020, the low wage index policy aimed to adjust hospital reimbursements to bridge the gap between high ...

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 inp...

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 enha...

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 m...

On Nov. 2, CMS finalized the calendar year 2024 Medicare Outpatient Prospective Payment System final rule . The 2024 OPPS final rule includes policies that will: add 10 services to the Inpatient Only list; establish an intensive outpatient program; expand the partial hospitalization program rate structure; update payment rates and policies for ambulatory surgical centers; update the requirements for the Hospital Outpatient Quality Reporting Program; outline quality program requirements for Rural Emergency Hospitals; and standardize the reporting of standard chart data using a CMS template. Read on to learn essential OPPS final rule information, important details and dates. We’ll also reveal how you can register for DataGen’s upcoming client exclusive OPPS rule analysis webinar . 4 key CMS 2024 OPPS final rule components 1. Expanded and updated rates CMS estimates a 2.1% rate increase for CY 2024, which represents a $6 billion increase in outpatient payments compared to the CY 2023 OPPS...

In August, CMS published the final Medicare Inpatient Prospective Payment rule for the federal fiscal year 2024. Most changes announced in the proposed rule were adopted and several are significant, including: Disproportionate Share Hospitals payment cuts; and a Rural Wage Index recalculation with diverse impacts. In this blog, we’ll cover these updates, the IPPS rule's total payment increase and how CMS continues to prioritize health equity in its rulemaking. The most significant IPPS final rule impacts 1. DSH UCC pool payment cuts For FFY 2024, DSH uncompensated care pool payments will decrease by $595 million due to decreased funding projections and a big adjustment to Factor 2 (see below), even though the DSH methodology is the same. This means DSH hospitals will need to find a way to recoup these losses, a challenge given the disadvantaged areas where they operate. If Affordable Care Act Marketplace plan enrollment continues to increase, Factor 2 cuts will continue. DSH UCC...

CMS’ proposed Calendar Year 2024 Medicare Home Health Prospective Payment System rule includes updates to: the Patient-Driven Groupings Model, Low Utilization Payment Adjustment thresholds, functional levels and comorbidity adjustment subgroups; estimated aggregate payments based on the 30-day payment rate to account for assumed versus actual behavior changes; the HH Value-Based Purchasing and Quality Reporting programs; home intravenous immune globulin items and services, and disposable negative pressure wound therapy device payment rates; medical equipment and supplies, including competitive bidding, as outlined by the Consolidated Appropriations Act of 2023; and provider and supplier enrollment requirements and oversight. The HH PPS rule also proposes to add a new Special Focus Program for low-performing hospices. CMS estimates that the rule will cut aggregate HH agency payments by $375 million nationally. This includes a -1.81% adjustment in the HH annual standard payment rate. Th...

The healthcare industry has seen considerable government policy changes over the years that significantly impact patients and providers alike. A recent proposed change is the Medicare Outpatient Prospective Payment System Remedy for 340B Drug Payment Policy proposed rule . Issued in response to the U.S. Supreme Court’s decision on American Hospital Association v. Becerra , the 340B proposed remedy rule would provide 340B hospitals that were improperly underpaid during calendar years 2018 through 2022 with a one-time lump sum payment. This blog post will delve into the proposed rule, the potential impact of changes that providers could face and what 340B hospitals can expect in terms of remedy payments. How the 340B proposed rule changes would impact providers Payment reduction The proposed rule includes significant changes that would impact providers. First is the estimated annual payment reduction to offset the 3.19% rate increase in calendar year 2018. This proposed change would res...

The Hospital Inpatient Prospective Payment System proposed rule for federal fiscal year 2024 includes a change to the rural wage index calculation that has the industry buzzing because it would affect all hospitals – rural and non-rural alike. If finalized, CMS will calculate each state’s RWI with data from rural hospitals and reclassified hospitals, even if those facilities are not rural geographically. As HealthLeaders notes , CMS’ approach since FFY 2020 has been to exclude reclassified hospitals from the rural floor calculation if they were not physically rural. Why the change? Who stands to lose or gain? And what other changes should hospitals watch for? What is the rural wage index? With the FFY 2024 rule, CMS proposes to reverse its exclusion of hospitals redesignated as rural from the RWI calculation. DataGen Senior Healthcare Data and Policy Analyst Jacob Orsini notes that hospitals can reclassify if they are either near a rural area or have a patient population with enough...