Medicare

Latest Issue of OR Manager
January 2021

COVID-19 has hastened outpatient surgery migration

The latest surge of COVID-19 cases has put many hospitals in a precarious position, with shortages of staff, space, and supplies. Lessons learned earlier in the pandemic cannot necessarily shore up systems that have been overwhelmed with patients. Throughout most of 2020, some patients postponed medical or surgical care. When…

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By: Elizabeth Wood
December 15, 2020
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CMS releases final 2021 Medicare payment rule for ASCs, HOPDs

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 2 released its 2021 final payment rule for ASCs and hospital outpatient departments (HOPDs). CMS has finalized the addition of 11 procedures to the ASC covered procedures list, including total hip arthroplasty, autochondrocyte knee implant, and open complex…

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By: Judy Mathias
December 3, 2020
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CMS releases final PFS for 2021, surgeons say rule jeopardizes care

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on December 1 released its 2021 final rule for the Medicare physician fee schedule (PFS), which expands telehealth services and increases payments for primary care and chronic disease management. The rule also reduces payments for surgeons, emergency physicians, and other…

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By: Judy Mathias
December 2, 2020
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Access OR Manager Conference sessions by December 31

For the first time in its history, the annual OR Manager Conference was held virtually September 30 to October 2. Many things were different this year, but the robust educational content and advanced technology were the same as in previous years. In a post-conference survey, more than 60% of respondents…

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By: Elizabeth Wood
November 17, 2020
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Shifts in case mix bode well for future of outpatient surgery

Before COVID-19 emerged as the biggest disruptor of 2020, many ambulatory surgery centers (ASCs) had been growing volume and receiving Medicare reimbursements for an increasing number of procedures. Stopping elective procedures in the spring was a significant setback, especially for smaller, independent facilities, notes a Global Healthcare Advisors (GHA) brief,…

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By: Elizabeth Wood
November 17, 2020
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Medicare to cover monoclonal antibody COVID-19 treatments

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on November 10 announced that Medicare will cover out-of-pocket costs for monoclonal antibody drugs for COVID-19 during the public health emergency. The agency’s coverage includes Eli Lilly’s bamlanivimab, which recently received an emergency use authorization from the Food and Drug…

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By: Judy Mathias
November 12, 2020
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CMS: How to prepare for COVID-19 vaccine

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on November 5 released a set of toolkits and enrollment actions to take to administer the COVID-19 vaccine when it’s available. Many Medicare-enrolled providers don’t have to take any actions until the vaccine is available. Some Medicare-enrolled providers must also…

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By: Judy Mathias
November 5, 2020
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CMS penalizes 2,545 hospitals for high readmissions

Editor's Note The Centers for Medicare and Medicaid Services (CMS) will penalize and reduce a year’s worth of payments to nearly half of the nation’s hospitals because of 30-day readmission rates, the November 2 Kaiser Health News reports. The penalties are part of the ninth year of the Hospital Readmissions…

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By: Judy Mathias
November 3, 2020
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CMS issues coverage plan for COVID-19 vaccines, treatments

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on October 28 issued an interim final rule that requires CMS to cover any COVID-19 vaccines that receive Food and Drug Administration (FDA) authorization at no cost to beneficiaries. The rule also will increase what Medicare pays hospitals for COVID-19…

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By: Judy Mathias
October 29, 2020
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CMS threatens to withhold payments from hospitals not reporting COVID-19, flu data

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on October 6 released guidance on how it will implement an interim final rule that requires hospitals and critical access hospitals to report data on COVID-19 and flu patients. CMS says failure to report specified data may lead to termination…

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By: Judy Mathias
October 8, 2020
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