When the federal government shutdown began on October 1, 2025, the Centers for Medicare and Medicaid Services (CMS) directed all Medicare Administrative Contractors (MAC) to implement a temporary claims hold of up to 10 business days to ensure that Medicare payments would be accurate and consistent with statutory requirements. CMS has now revised its instructions to limit the claims hold only to those “services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025”.
Categories:
medicare,
medicare reimbursement,
cms
The Centers for Medicare and Medicaid Services (CMS) announced its Medicare Physician Fee Schedule (MPFS) Final Rule for 2024, including provisions for both Medicare reimbursement and the Quality Payment Program (QPP).
Categories:
interventional radiology,
cms,
MPFS,
radiology,
QPP,
diagnostic radiology
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During the COVID-19 Public Health Emergency, states were required to maintain enrollment of nearly all Medicaid enrollees as a condition of receiving a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) increase under the Families First Coronavirus Response Act (FFCRA). There was significant growth of national Medicaid enrollment figures due to this continuous Medicaid enrollment requirement, coupled with additional incentives for states to implement Medicaid expansion. The Kaiser Family Foundation estimates that the combination of Medicaid and CHIP (Children’s Health Insurance Program) enrollment has increased by over 23 million people between February 2020 and March 2023. However, when that continuous enrollment condition ended on March 31, 2023, Medicaid enrollment numbers started to decline. States had to resume normal operations, including restarting full Medicaid eligibility renewals and terminations of coverage for individuals who are no longer eligible. The full process could take up to a year, with the earliest removals from coverage having begun in April 2023.
Categories:
cms,
radiology,
medicaid
The Centers for Medicare and Medicaid Services (CMS) press release announcing the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2023 highlights expanded access to behavioral health services, Accountable Care Organizations (ACO), cancer screening, and dental care. Of these areas, cancer screening could be important to radiology practices, but the news was not good – CMS declined to include CT colonography coverage while it expanded coverage for traditional colonoscopy. The MPFS regulates the Medicare fee schedule payment provisions as well as the Quality Payment Program (QPP).
Categories:
radiology reimbursement,
cms,
MPFS,
MIPS,
MIPS participation,
radiology,
QPP
Keeping abreast of the various healthcare rules and regulations from federal and state authorities can sometimes be overwhelming for a practice’s management. Here is a summary of some of the most important regulatory issues to be aware of for next year, along with a few payment policy decisions that are not governmental. The links will take you to our recent articles and other sources that probe each topic in more depth.
Categories:
cms,
MPFS,
low dose CT,
CPT codes,
radiology,
QPP,
surprise billing
Coming a bit earlier in the month than usual, the release of the Medicare Physician Fee Schedule (MPFS) Final Rule for 2022 contains few changes from the rule proposed earlier this year. The Proposed Rule reported a 2022 Conversion Factor (CF) of $33.5848 per Relative Value Unit (RVU), but the Final Rule adjusts the figure slightly upward to $33.5983. This is a reduction of 3.71% from the 2021 CF of $34.8931. In addition to this cut, practices will see an additional 2% payment reduction when sequestration resumes on January 1, 2022.
Categories:
cms,
MPFS,
Quality Payment Program,
radiology,
quality measures,
Medicare Physician Fee Schedule
It seems that diagnostic imaging and radiology are often blamed for increasing the cost of healthcare, especially Medicare costs. Not so, says a recent study that was reported in Radiology Business on August 30, 2021.
Categories:
medicare,
cms,
radiology
The Centers for Medicare and Medicaid Services (CMS) has released its proposed changes to the Medicare Physician Fee Schedule (MPFS) for 2022. The Proposed Rule is usually modified somewhat before it becomes the final rule for each year, but it gives an idea of the direction Medicare reimbursement is headed. The Medicare Proposed Rule contains payment policy decisions as well as changes to the Quality Payment Program (QPP).
Categories:
cms,
MPFS,
radiology
The guideline for LDCT lung cancer screening reimbursement for older adults have changed in recent years. In late 2021 and early 2022, both the U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) updated their reimbursement criteria, expanding the age range and smoking history requirements so that more adults can address potential concerns sooner. As a radiology practice, this is important news for how you deliver your services and submit them for reimbursement. Learn more about you need to know with Healthcare Administrative Partners.
Categories:
radiology reimbursement,
cms,
radiology,
lung cancer screening
The Quality Payment Program (QPP) continues to be modified due to the COVID-19 public health emergency. The Centers for Medicare and Medicaid Services (CMS) recently announced some leeway for clinicians affected by the pandemic in 2020 and 2021.
Categories:
radiology reimbursement,
cms,
QPP,
COVID-19
