IPPS and LTCH Final Rule FY2019

On October 8, 2018, in Documents, by pam

On August 2, 2018, CMS released the Final Rule for IPPS and LTCH for FY2019. Corrections were issued September 28, 2018. We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. […]

CMS Data Files for Inpatient Rehabilitation Facilities

On September 20, 2018, in Documents, by AQ-IQ LLC

FY 2019 IRF PPS Final Rule Data Files (83 FR 38514) IRF Rate Setting Final Rule (83 FR 38514)  This file contains data for each of the 1,126 inpatient rehabilitation facilities used to estimate the policy updates in the inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in […]

IRF PPS Final Rule FY2019

On September 13, 2018, in Documents, by AQ-IQ LLC

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2019. As required by the Social Security Act (the Act), this final rule includes the classification and weighting factors for the IRF prospective payment system’s (PPS) case-mix groups and a description of the methodologies and data used […]

IRF-PAI Manual

On August 30, 2018, in Documents, by AQ-IQ LLC

Version 3.0 for 2019 is now available Final IRF-PAI Version 3.0 – Effective October 1 2019 (FY2020) [PDF, 449KB] Final IRF-PAI Version 3.0 Change Table [PDF, 242KB] Version 2.0 is effective 10/1/18 IRF-PAI Training Manual V2.0 Errata – July 2018 [ZIP, 131KB] Final IRF-PAI Version 2.0 – Effective October 1 2018.pdf  Earlier information: 2017 IRF-PAI […]


On August 1, 2018, in Documents, by AQ-IQ LLC

On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and inpatient procedures were replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Click […]

Biosimilar Action Plan (BAP)

On July 18, 2018, in Documents, Industry News, by AQ-IQ LLC

Read the FDA’s Action Plan here Excerpts from the plan:  Generic drugs, for instance, represent 90 percent of all prescriptions in the U.S.1 Generic competition facilitated by the 1984 Hatch Waxman Act provided savings of more than $1 trillion to the U.S. health care system over a decade and generated $265 billion in savings in […]

Physician Fee Schedule CY2019 Proposed Rule

On July 12, 2018, in Documents, Industry News, by AQ-IQ LLC

Today, the Centers for Medicare & Medicaid Services (CMS) proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the […]

Proposed Rule Medicaid Provider Reassignment

On July 12, 2018, in Documents, Industry News, by AQ-IQ LLC

Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicaid Provider Reassignment regulation that would eliminate state’s ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute. This proposed regulatory change is designed to ensure that taxpayer dollars dedicated to providing healthcare services for low-income […]


On July 11, 2018, in Documents, Industry News, by AQ-IQ LLC

Today, the Centers for Medicare & Medicaid Services (CMS) proposed innovative changes to the payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) program. The DME proposals in the proposed rule released today aim to increase access to items for patients and simplify Medicare’s DMEPOS Competitive Bidding […]