Becky Brugler’s Post

#CMS is pushing out all of its final rules. Below is a great snapshot of the final payment updates for fee for service in 2025 (courtesy Hospitalogy)

CMS just released the 2026 Medicare Advantage & Part D Advance Notice, along with the Draft CY 2026 Part D Redesign Program Instructions. These documents are packed with important updates that will shape the future of Medicare. Here are some key highlights: • Government Payments to MA Plans: Payments are projected to increase by 4.33%! A total of over $21 billion from 2025 to 2026. • Risk Adjustment Phase In: CMS is wrapping up its 3 year phase in of improvements to the MA risk adjustment model and the way medical education costs are factored into growth rates. • Growth Rate Details: The effective growth rate reflects both underlying FFS trends and restatements. For a deeper dive into the numbers, including the impact of billing anomalies like synthetic skin, check out the “FFS Trends” section of the supporting materials. • MA Program Stability: Even during these transitions, MA rebates have stayed steady at over $2,400 annually per enrollee, showing that payments are more than sufficient to maintain program stability. Without the proposed updates, MA plans would see $10.4 billion in additional payments in 2026, money that isn’t necessary to keep the program stable. • Part D Redesign: The redesign continues, with out of pocket costs for Part D beneficiaries capped at $2,100 in 2026, a big win for affordability. Public comments are due by February 10, 2025, and the final documents will be out by April 7, 2025. Looking ahead, Medicare is set to spend $9.2 trillion on MA payments over the next decade. Accurate payments and efficient policies are essential to preventing waste and ensuring beneficiaries get the care they need. These proposals are a step in the right direction; balancing fiscal responsibility with better outcomes and access for people with Medicare. For those of us in this space, it’s encouraging to see data driven changes that prioritize stability, quality, and affordability. #Medicare #MedicareAdvantage #AdvancedNotice #PartD

Heavy and useful info from Angela Jordan, CPC, CPMS, COBGC, about the changes in Medicare Documentation with which your organization might be struggling. #emceeonly #CWAI

The following outline highlights the key aspects of Medicare coding and billing for procedures performed in ASCs, particularly focusing on the new complexity codes introduced in 2023 and their impact on 2024 billing. Read more: https://lnkd.in/g6GkZGb6

Many of our Endovascular/Interventional OBL clients are evaluating whether to open an ASC or hybrid OBL/ASC. There are compelling reasons to consider this strategy. This article reviews the medical coding/billing aspects ASCs and shows reimbursement comparisons for selected cases.

Very nice article that raises excellent points. Choosing whether to open an OBL, hybrid OBL/ASC, or ASC depends on 3 things: 1. How well have you negotiated your insurance contracts? 2. How well have you negotiated your insurance contracts? 3. How well have you negotiated your insurance contracts? Regardless of which entity you open, keep in mind that it is an expensive endeavor. While ASCs may reimburse more than OBLs, the costs in running an ASC are also higher. If you don’t negotiate your contracts, you may end up getting reimbursed marginally higher than an OBL but have higher expenses and thus run the risk of bankruptcy. Remember, you don’t get what you deserve. You get what you negotiate!

#CMS #HPMS #MedicareAdvantage CMS just released the Advance Notice of Methodological Changes for Calendar Year (CY) 2026 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. Another CMS Friday release, another fun weekend of reading! 😆

📰 CMS issues a final rule (CMS-1799-F) on Medicare program mitigating the impact of highly suspect billing activity on Medicare Shared Savings Program. This rule is part of a larger CMS strategy to address suspect billing activity within ACOs.

On November 1, #CMS released the CY 2025 #OPPS final rule with updates for HOPDs and ASCs. CMS estimates payments to hospitals will increase by $1.98 billion in 2025, excluding enrollment, case mix, and utilization changes. See our takeaways from this important final rule: https://bit.ly/4fKUxr2

From shared savings to collaborative participation to better coordination of care, specialty care is vital to the successful equation of value based care and health equity.