Site-Neutral Payments Stand: SCOTUS Declines to Hear AHA Appeal, Preserving Lower Payments to Off-Campus Provider-Based Departments | Sheppard Mullin Richter & Hampton LLP jdsupra.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from jdsupra.com Daily Mail and Mail on Sunday newspapers.
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On April 29, 2021, CMS issued a final rule extending the Comprehensive Care for Joint Replacement (CJR) bundled-payment model for an additional three performance years (the Final Rule). Originally slated to end September 30, 2021, the CJR program will now extend through December 31, 2024. The Final Rule also makes a number of changes to the program moving forward, including broadening the scope of a CJR episode to include lower extremity joint replacement procedures performed in the hospital outpatient department setting.
Started in April 2016, the CJR Model is an episode-based bundled payment initiative for hip and knee replacements the most common inpatient services for Medicare beneficiaries. Under the current CJR Model, the episode begins with an inpatient hospitalization for a knee or hip replacement and runs through 90-days post-discharge. Participating hospitals are paid one retroactive payment for all services inc
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On January 19, 2021, CMS announced the results of its audit of off-campus outpatient departments claiming the “mid-build” exception following enactment of the 21st Century Cures Act (the Cures Act). Of the 334 providers that CMS audited, only 132 providers qualified for the mid-build exception. The Cures Act required that CMS complete these audits no later than the end of CY 2018, but CMS only announced the results of those audits on the last full day of the prior administration. Despite the long delay, CMS had previously stated that hospitals that reasonably believed they qualified for the exception could bill for services provided in mid-build facilities at full Outpatient Prospective Payment System (OPPS) rates. Denials now call into question whether affected hospitals must repay the difference between excepted and non-excepted rates for nearly four years of claims. King & Spalding has received feedback from many ho
At long last, the Centers for Medicare and Medicaid Services (CMS) has issued decisions on provider applications for the mid-build exception. Nearly four years after the deadline for.
Strontium89 Now Reimbursed in Hospital and Outpatient Settings for Metastatic Bone Pain Treatment
Strontium89 Now Reimbursed in All Treatment Settings
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NEW YORK, Jan. 7, 2021 /PRNewswire/
Q BioMed Inc. (OTCQB: QBIO), a commercial stage biotech company, announced today that the Centers for Medicare and Medicaid Services (CMS) updated the Outpatient Prospective Payment System (OPPS) reimbursement rate for its FDA approved non-opioid metastatic bone pain drug
Strontium89 (Strontium Chloride Sr-89 Injection, USP) on January 3, 2021. The update ensures all Medicare patients have access to Strontium89 in the appropriate setting.
The Q1 2021 Strontium89 reimbursement update was expected by Q BioMed as part of the standard CMS quarterly OPPS update, and is an important milestone. While Strontium89 has been appropriately reimbursed in the free standing clinic setting since launch, it was under-reimbursed in the hospital outpatient setting where