Improper Payment Reporting Criteria November 25 2022
Improper Payment Reporting Criteria The Payment Integrity Information Act of 2019 defines significant improper payments as either: (i) improper payments greater than $10 million and over 1.5 percent of all payments made under that program, or (ii) improper payments greater than $100 million. The Medicare Fee-For-Service (FFS), Medicare Part C, Medicare Part D, Medicaid, Children’s Health Insurance Program (CHIP), and Affordable Care Act Health Insurance Exchange Advance payment of the Premium Tax Credit (APTC) program are susceptible to significant improper payments. What You Need to Know: Improper payments represent payments that do not meet program requirements. The vast majority of improper payments occur in situations where there was an unintentional payment error or a reviewer cannot determine if a ...read more
Final rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facility November 25 2022
On July 27, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year (FY) 2023. CMS is publishing this final rule consistent with the legal requirements to update Medicare payment policies for IPFs on an annual basis. This fact sheet discusses the major provisions of the final rule, including a permanent 5% cap policy to smooth the impact of year-to-year changes in IPF payments related to decreases in the IPF wage index. CMS is not finalizing any changes for the IPF Quality Reporting Program in this FY 2023 final rule. The FY 2023 IPF PPS final ...read more
CMS Urges Timely Patient Access to COVID-19 Vaccines, Therapeutics November 25 2022
Today, the Centers for Medicare & Medicaid Services (CMS) issued new guidance that highlights the need for health care providers and suppliers to ensure patients have access to the latest available COVID-19 vaccines and therapeutics. In particular, CMS is reminding nursing homes that they are required to offer the COVID-19 vaccines, including any updated COVID vaccines, to residents. In a new Quality, Safety & Oversight (QSO) memo, CMS reinforces the importance of COVID-19 treatments for preventing serious illness from COVID-19 and saving the lives of high-risk individuals who would otherwise be at risk of severe complications. CMS is also reemphasizing the need for providers and suppliers to stay up to date with COVID-19 vaccinations, including any updated COVID vaccines, ...read more
3.4 million Americans have signed up for 2023 individual market health insurance coverage through the Marketplaces November 25 2022
The Centers for Medicare & Medicaid Services (CMS) reports that nearly 3.4 million Americans have signed up for 2023 individual market health insurance coverage through the Marketplaces since the start of the 2023 Marketplace Open Enrollment Period (OEP) on November 1. This includes 3.0 million plan selections in the 33 states using the HealthCare.gov platform for the 2023 plan year, through November 19, 2022 (Week 3), and 387,000 plan selections in 16 states and the District of Columbia with State-based Marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through November 12, 2022 (Week 2). Total nationwide plan selections include 655,000 consumers (19% of total) who are new to the Marketplaces for 2023, and 2.7 million consumers ...read more
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11/25/22 Improper Payment Reporting Criteria
11/25/22 Final rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facility
11/25/22 CMS Urges Timely Patient Access to COVID-19 Vaccines, Therapeutics
11/25/22 3.4 million Americans have signed up for 2023 individual market health insurance coverage through the Marketplaces
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