Proposed Payment Systems and Fee Schedules in 2023
Proposed rules revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) services, along with new physician fee schedule (PFS) rule sets will significantly impact providers in 2023.
Rules and Regulations Affecting Revenue
A number of payment rule changes and unknown future federal and state regulations loom ahead.
Interpreting Payment Rule and Revenue Cycle Terminology
Understanding terms used in rule sets pertaining to payment for inpatients, which go into effect during the fiscal year effective Oct. 1, as well as outpatient and physician fee services, which go into effect during the calendar year effective Jan. 1.
2022 Proposed OPPS/ASC and PFS Payment Rules: The Impact on Pharmacy
The proposed 2022 outpatient prospective payment system (OPPS)/ambulatory surgery center (ASC) and physician fee schedule (PFS) rule sets impact all pharmacy practices.
Provider, Supply Chain and Payer Negotiations
In today’s fast-paced healthcare industry, naiveté about payers’ requirements coupled with their supply chain stipulations can lead to reimbursement shock!
Preparing for Possible Drug Pricing Changes
The COVID-19 pandemic that has pushed the U.S. healthcare system to its limits and crippled the economy has brought stark attention to the need for new legislation to lower medication prices.
COVID-19 Business Recovery
Life during the COVID-19 pandemic is surreal even after a year. Healthcare organizations are being pressured to do more with less while at the same time contribute revenue to whittle away at staggering losses.
Proposed Payment Rules and Court Rulings
Two court rulings and segments of the proposed OPPS/ASC and PFS rules may require action from providers to recover expenses caused by the COVID-19 pandemic.
A Guide to Immune Globulin Billing and Reimbursement
Reimbursement for expensive immune globulin (IG) therapies can be challenging and frustrating for providers. Here’s a guide to help ensure they are reimbursed for the cost of these medications.
Complying with Rules Ensures Reimbursement for Drugs
Healthcare costs continue to rise and payment models subsequently evolve, payers nevertheless largely decide which expensive high-investment drugs will be reimbursed and under what circumstances.
