CMS reports Medicare fee-for-service improper payments at $28.8 billion in fiscal 2025, with a 6.55% improper payment rate, down from 2024.

Physicians are concerned about Medicare’s proposed physician pay cuts for 2024 — which would reduce the conversion factor by $1.14 (3.34 percent) — and argue the lack of clinically relevant ...

Difference in spending attributed to "coding intensity" and "favorable selection" ...

While CMS could improve its payment policies and information sharing, those changes are unlikely to make much of a difference so long as it’s easy for providers to make money through fee-for-service ...

The CY 2026 Physician Fee Schedule Proposed Rule (PFS Proposed Rule) introduces significant changes to how drug manufacturers must treat Bona Fide Service Fees (BFSFs) when calculating Average Sales ...

The Centers for Medicare and Medicaid Services plans to issue rules to bring reimbursements from Medicaid managed care plans in line with the rates set under fee-for-service systems, the agency ...

CMS’ decision to phase out the Medicare Inpatient Only list in 2026 marks a consequential site-of-service policy that could rapidly accelerate the migration of complex procedures to outpatient ...

In an effort to reduce colonoscopy access barriers, CMS is proposing that follow-up colonoscopies to at-home tests be considered a preventive service. CMS issued the calendar year 2023 physician fee ...

On July 21, 2022, the Centers for Medicare & Medicaid Services (“CMS”) released its first-ever nationally standardized Home- and Community-Based Services (“HCBS”) quality measure set to encourage ...

Doctors could get a small decline in their Medicare payments next year under a new rule proposed by the Centers for Medicare & Medicaid Services (CMS), which is also proposing new options to cover ...