The Work Plan describes the primary objectives and provides for each review its internal identification code and the year in which OIG expects one or more reports to be issued as a result of the review. Get the PDF (80 pages)
Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) […]
This proposed rule would lay out a structure and options for coordinating Medicaid, CHIP, and Exchange eligibility notices and appeals; provide additional benefits and cost-sharing flexibility for state Medicaid programs; and codify several provisions included in the Affordable Care Act and Children’s Health Insurance Program Reauthorization Act (CHIPRA). Key Provisions Process for Appeals of Eligibility […]
Procedures That Will be Paid Only as Inpatient for CY2013 This is a zip file for download. CPT® license agreement required. CY2013 OPPS Addenda [ZIP, 2.1 MB] (The 2013 Inpatient Only List is here as Addendum E.)
This final rule implements Medicaid payment for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule […]
RAC Focus: Automated Denials
The state of Washington will become the first state to partner with the Centers for Medicare and Medicaid Services (CMS) in the Financial Alignment Demonstration to test a managed-fee-for-service model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Through the Demonstration, Washington will use a managed-fee-for-service care model that will build upon […]
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, doctors, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record (EHR) technology. More than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate in […]
CMS has issued a proposed rule that would update Medicare policies and payment rates for End-Stage Renal Disease (ESRD) facilities paid under the ESRD Prospective Payment System (PPS) for calendar year (CY) 2013. The proposed rule would also strengthen incentives for improved quality of care and better outcomes for patients through improvements to the ESRD […]