PPS reimbursement alerts

This one-time notification (CR 14553) targets A/B MACs Part A and the Fiscal Intermediary Shared System (FISS), with an implementation date of January 4, 2027. The transmittal subject is truncated, so

This transmittal (CR 14457) extends the default recoupment date for Part A cost report overpayments and revises related processes, effective January 4, 2027. Billing teams at Part A providers (hospita

This transmittal implements the annual IRF PPS update effective for services on or after October 1, 2026 (FY2027). Billing teams must ensure claims processing systems are updated by October 5, 2026 to

This transmittal implements FY 2027 MS-DRG updates effective October 5, 2026, impacting inpatient hospital claims processing. Billing teams must update their grouper software and charge description ma

CMS finalizes FY2027 IPPS and LTCH PPS payment rates effective October 1, 2026, revising operating and capital payment systems for acute care hospitals and long-term care hospitals. The rule updates G

This transmittal adjusts the hourly salary equivalency amount and monthly inflation factors for Critical Access Hospitals (CAHs). Billing teams at CAHs should review updated cost report calculations a

This active final LCD from Wellpoint Federal governs coverage criteria for psychiatric inpatient hospitalization under both Part A and Part B, effective April 1, 2026. It establishes the medical neces

CMS is expanding the Supplemental Security Income (SSI) ratio data used in the Inpatient Provider Specific File, with implementation effective July 4, 2027. This change affects how SSI ratios are calc

CMS is implementing the FY 2027 annual update to the Medicare Code Editor (MCE) and ICD-10 code sets, effective October 5, 2026. Billing teams must update their claim editing systems and encoders to r

This transmittal implements CR 14262, directing systems to send Transplant Program Hospital Type and new organ type data to Fiscal Intermediaries/MACs. Billing teams should verify that transplant prog

CMS announces a virtual public meeting of the Advisory Panel on Hospital Outpatient Payment scheduled for August 24, 2026. The Panel advises on the clinical integrity of Ambulatory Payment Classificat

CMS proposes updates to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems for CY2027, including revised payment rates and quality reporting

This transmittal implements editing for Programs of All-Inclusive Care for the Elderly (PACE) inpatient claims, effective April 6, 2026. Billing teams should review PACE inpatient claim submissions to

CMS is releasing the July 2026 Integrated Outpatient Code Editor (I/OCE) Specifications Version 27.2, effective July 6, 2026. This update modifies the logic used to edit and process outpatient claims,

This transmittal updates Chapter 40 of the Provider Reimbursement Manual, which governs the Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552). Billing and cost reporting teams shou

The July 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS) affects billing practices by updating payment rates and possibly introducing new service codes. Billing teams must rev

The correction of a typographical error in the Medicare proposed rule could have minimal impact on billing and reimbursement processes for hospitals. However, providers should stay informed about any

The recent court decision has led to significant revisions in the Medicare wage index values for FY 2025, which will impact inpatient hospital reimbursement rates. Hospitals, especially low wage ones,

The recent correction in the final rule for the Hospital Inpatient Prospective Payment Systems (IPPS) may affect reimbursement rates for acute care and long-term care hospitals. These adjustments, alo

The announcement of the inpatient hospital deductible and coinsurance amounts for CY 2026 will directly impact hospital billing processes and patient reimbursement calculations under Medicare Part A.

The updated inpatient hospital deductible for CY 2025 will be set at $1,676, which may impact hospital revenue cycles and patient billing. Daily coinsurance rates for inpatient and skilled nursing ser

Starting January 1, 2024, the inpatient hospital deductible will increase to $1,632, impacting hospital reimbursement rates. Additionally, the updated coinsurance rates will apply for extended care se

This correction to the CY 2026 OPPS/ASC final rule addresses technical errors, which may affect the accuracy of reimbursement amounts for outpatient services and surgical centers. Accurate coding and

The upcoming Advisory Panel meeting may lead to adjustments in payment classifications for outpatient services, impacting reimbursement rates under the Medicare Hospital Outpatient Prospective Payment

The recent correction to the Hospital Outpatient Prospective Payment System reaffirms reimbursement protocols that impact outpatient services and ambulatory surgical centers. Stakeholders must be awar

The upcoming Advisory Panel meeting will influence the clinical integrity of payment classifications vital to the Hospital Outpatient Prospective Payment System (OPPS). Adjustments and recommendations

The proposed rule regarding the 340B-acquired drug payment policy could significantly impact reimbursement rates for outpatient services related to such drugs. Stakeholders are encouraged to provide c

The new Medicare program rule could significantly impact reimbursement rates for hospital outpatient departments and ambulatory surgical centers. With proposed changes to quality reporting and service

The recent updates in the Hospital Outpatient Prospective Payment System emphasize new payment policies and conditions of participation for services offered by rural emergency hospitals. This will imp

The proposed changes to the Hospital Outpatient Prospective Payment System could significantly affect reimbursement strategies for outpatient services, particularly in rural areas. Additionally, updat

The Advisory Panel on Hospital Outpatient Payment meeting will influence Medicare's OPPS and associated weights for Ambulatory Payment Classification groups. Changes in these classifications can signi

The proposed rule addresses adjustments to the 340B-acquired drug payment policy, which may significantly impact reimbursement for hospital outpatient services. This change could lead to improved fina

The correction of technical errors in the Hospital Outpatient and Ambulatory Surgical Center payment systems ensures clarity in billing and reimbursement practices, potentially enhancing compliance an

The proposed rule correction addresses technical errors impacting billing clarity for Medicare and Medicaid reimbursement processes, particularly pertaining to the Inpatient Prospective Payment System

The upcoming town hall meeting presents a critical opportunity for stakeholders to discuss the implications of new technology add-on payments under the IPPS. The outcomes of this meeting could signifi

The announcement of a town hall meeting regarding the FY 2026 applications for new medical services and technologies under IPPS may influence reimbursement rates as hospitals seek to incorporate these

The recent correction in the Hospital Outpatient Payment System may affect reimbursement rates for outpatient services and intensive outpatient programs. It is essential for providers to stay updated

The recent corrections to the FY 2024 IPPS/LTCH PPS final rule ensure accurate implementation of payment systems, which may affect reimbursement rates for acute care hospitals and long-term care facil

The town hall meeting provides an opportunity for stakeholders to influence the FY 2025 add-on payments under IPPS. Engaging in this dialogue can impact reimbursement rates for new medical services an

The proposed rule aims to revise payment rates and policies for acute care hospitals and long-term care hospitals, which could significantly impact reimbursement structures for inpatient services. Cha

The proposed rule aims to boost the procurement of American-made PPE and essential medicines in Medicare participating hospitals, potentially leading to reimbursement adjustments that reflect the incr

The upcoming changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center payment systems for 2026 may significantly affect reimbursement rates for various outpa

The final rule for FY 2026 updates the Hospital Inpatient Prospective Payment System, impacting reimbursement rates for acute care and long-term care hospitals. With revisions due to legal decisions a

The proposed rule aims to revise the OPPS and ASC payment systems for 2026, which will potentially affect reimbursement rates for hospital outpatient services. Additionally, updates to quality reporti

The proposed rule outlines significant updates to the Medicare inpatient prospective payment systems, which will directly impact the reimbursement rates for acute care hospitals and long-term care hos

The solicitation for additional participants in the Rural Community Hospital Demonstration Program may affect reimbursement structures for facilities participating in rural healthcare services. Enhanc

The upcoming changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system are poised to affect reimbursement rates significantly. P

The implementation of an appeals process for Medicare beneficiaries reclassified from inpatient to outpatient status may lead to increased administrative burdens for providers who must navigate new bi

The correction to the FY 2025 IPPS/LTCH PPS final rule will have minimal impact on billing and reimbursement as it primarily addresses technical and typographical errors. Providers should remain aware

The new rule introduces revisions to the Medicare inpatient prospective payment systems, directly impacting reimbursement rates for acute care hospitals. Updates to payment policies for long-term care