Medicare and Medicaid Payment Systems

Current trends and activities surrounding Hospital Outpatient Prospective Payment System (HOPPS), Medicare Physician Fee Schedule (MPFS), alternative payment models and more.

Clinical Labor Update Proposal: 黑料网 Urges CMS to Protect Patient Access to Care

Updates to clinical labor staff pricing in the 2022 Medicare Physician Fee Schedule (MPFS) proposed rule would significantly impact radiology reimbursement, especially for interventional radiology and radiation oncology.
Learn more about this threat to patient access to care


Evaluation and Management

黑料网 urges Congress to avoid radiology cuts by waiving budget neutrality for Medicare E/M changes.

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Quality Payment Program: Alternative Payment Models

Understand M黑料网A, stay informed on its implementation, and take steps to thrive in new payment and delivery models.
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Medicare Physician Fee Schedule

CMS uses the MPFS to reimburse physician services; it is composed of resource costs associated with physician work, practice expense and professional liability insurance.
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National and Local Coverage Determinations

By reviewing and commenting on Local Coverage Decisions and proposed policy changes, the 黑料网 Carrier Advisory Committee networks help ensure members are appropriately reimbursed for medically reasonable and necessary services provided to Medicare patients.
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Development of Resource-Based Values

The 黑料网 is represented on the RU and submits recommendations to the AMA on radiology-related codes.
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Hospital Outpatient Prospective Payment System

CMS developed HOPPS to reimburse providers for hospital outpatient services using Ambulatory Payment Classifications.
Latest HOPPS information


Medicaid

The 黑料网 monitors local Medicaid programs and reviews local coverage policies. In addition, our network's relationships with large, multistate Medicaid MCOs allows the 黑料网 to have valued input in reviewing and commenting on medical coverage policies.
Additional Medicaid information


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