On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Final Rule (FR). The rule includes payment and quality provisions that will take effect on January 1, 2022. In addition, CMS produced a fact sheet summarizing the key provisions of the FR.Read More
Background On October 7, 2021, the Department of Health and Human Services (HHS), in conjunction with the Office of Personnel Management (OPM), Department of the Treasury (DOT), and Department of Labor, including the Internal Revenue Service (IRS) and Employee Benefits Security Administration (EBSA) (collectively “the Departments”), published the second iteration of the interim final rulesRead More
Insurance payers have recently issued a number of policies aimed at redirecting patient care with the goal of steering patients to treatment outside of hospital settings. In their attempts to do so, payers are disregarding prexisting contracts with providers and complicating the patient experience and pre-authorization processes. These policies make it increasingly difficult for providers to deliver exceptional patient experiences without a negative impact on their bottom line.Read More
Recent regulatory updates and payer policy changes could have a big impact on providers’ operations and bottom line. Ensemble’s experts break down the top five macro-trends you and your organization need to know about now to avoid underpayments, denials, and impacts on patient volume. Trend #1: Payers becoming providers The line between payer and providerRead More
CMS Proposes to Repeal Rules Designed to Provide Faster Access to Latest Medical Technology Leaves Open Window for Commercial Insurance Policy to Factor into All Medicare Part A and B Coverage Determinations Background On September 15, 2021, the Centers for Medicare and Medicaid (CMS) published a proposal to repeal (herein after Proposed Repeal or Proposal)Read More
There are those people who appear to carry on despite challenges or difficult conditions. What is their secret? Chances are, it’s empathy. Or more specifically, they are tapped into the stress-relieving powers of compassionate empathy.Read More
Keeping up with policy changes and proposed rules by the Centers for Medicare and Medicaid Services (CMS) throughout the year can be daunting, so let us take that off your plate.
Ensemble’s team of healthcare experts is here to bring you the information you need to know, the dates you need to mark, and the links you need to bookmark to ensure your organization has a voice in upcoming regulations and is preparing for impending policy changes.
One critical change in CMS’ 2022 Medicare OPPS/ASC proposed rule is the reversal of last year’s initiative to eliminate the inpatient-only (IPO) list. Make sure your organization is prepared for the impact.Read More
The long-anticipated regulations prohibiting balance billing as set forth in the No Surprises Act were announced earlier this year and are scheduled to take effect January 1, 2022.
Learn how your organization can prepare to implement the operational practices necessary by downloading our report.Read More
White-bagging policies like Aetna’s present a number of issues for providers including decreased net revenue, increased cost associated with storing and preparing white-bag drugs, as well as increased statutory and regulatory compliance risk.Read More