Regulatory Bulletins
Key takeaways and insights from CMS updates
Regulatory Bulletin- April 2023: CMS-4201-F
CMS Has Issued the 2024 Medicare Advantage and Part D Final Rule
Providing Explicit Guidance to the Industry
Bulletin 17 – CMS 2023 OPPS & ASC Final Rule
On November 1, 2022, CMS released the CY 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System (ASC) Final Rule with Comment Period (CMS–1772–FC), with the official Federal Register publication scheduled to occur on November 23, 2022. The comment period for the Final Rule will remain open until January 1, 2023.
Bulletin 16 – CMS 2023 IPPS & LTCH Final Rule
On August 1, 2022, CMS released the FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS) Final Rule (CMS–1771–F), which was finalized and became effective on November 1, 2022.
Bulletin 15 – What you need to know about the OIG April 2022 Report
Versalus Health Comments on the April 2022, Office of Inspector General Report on “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care” Summary: The Center for Medicare and...
Bulletin 14 – CMS updates to MCPM Ch. 30
CMS Issues Update to the Medicare Claims Processing Manual Chapter 30 Section 200: Financial Liability Protections Overview On January 21, 2022, CMS released a Medicare Learning Matters (MLN) announcing a change request (CR 12546), resulting in substantial edits to...
Bulletin 13 – OPPS
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule Overview On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...
Bulletin 12 – OPPS
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule Overview On July 19, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical...
Bulletin 11 – April 2021 Livanta New Contract Announcement
BFCC-QIO National Claim Review Contract Awarded for Short Stay and Higher-Weighted Diagnosis Related Group (HWDRG) Claims Overview Livanta, a Centers for Medicare & Medicaid Services’ (CMS) Beneficiary and Family Centered Care – Quality Improvement Organization...
Bulletin 10 – IPO List Regulatory and Operational Compliance Considerations
Elimination of the Inpatient-Only List Regulatory and Operational Compliance Considerations Overview The CY 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) Final Rule[1] included the Inpatient Only (IPO) List phase-out over 3 years. Over...
Bulletin 09 – 2020-12-04_CMS CY 2021 OPPS Final Rule Bulletin
CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC) Executive Summary of Final Rule On December 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the...
Bulletin 08 – 2020-10-22 CMS FY 2021 IPPS LTCH Final Rule Bulletin
CMS FY 2021 IPPS & LTCH Final Rule (CMS-1735-F) Executive Summary of Changes On September 2, 2020, the Centers for Medicare & Medicaid Services (CMS) published the FY 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care...
Bulletin 07 -CMS Waiver Does Not Change Beneficiary Rights And CC 44 Billing Requirements
Blanket Waiver of the Utilization Review Standards of the Condition of Participation Does NOT Waive Beneficiary Rights & Condition Code 44 Billing Requirements! Last week, the Centers for Medicare and Medicaid Services (CMS) waived “the entire utilization...
Bulletin 06 – CMS Waivers to Utilization Review Conditions of Participation
Versalus Health’s Comments on CMS’ Waivers to Utilization Review Conditions of Participation On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) published additional blanket waivers in response to the COVID-19 pandemic. There are a number of...
Bulletin 05 – COVID-19
COVID-19-Related Considerations When Determining Medicare & Medicare Advantage Admission Status 1. Public Health Emergency Declarations As utilization review and compliance experts within your hospitals, it is imperative that you understand the impact that waivers...
Bulletin 04 – CMS Revisions to Requirements for Discharge Planning for Hospitals
Versalus Health’s Comments on CMS’ Revisions to Requirements for Discharge Planning for Hospitals On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) published a new Final Rule, Revisions to Discharge Planning Requirements (CMS-3317-F). The...
Bulletin 03 – The Removal of Total Hip Arthroplasty from the Inpatient Only List
The Removal of Total Hip Arthroplasty from the Inpatient Only List The Medicare Inpatient-Only (IPO) list includes procedures that are typically provided only in the inpatient setting and paid under the Hospital Inpatient Prospective Payment System (IPPS)1. Each year,...
Bulletin 02 – Versalus Legislative IPO Update
FY 2019 Inpatient Only Procedure List Regulatory Update Develop and implement a process that involves your cardiac catheterization teams NOW to ensure the placement of the correct admission status order for the inpatient only procedures described by CPT 92941 or HCPCS...
Bulletin 01 – Inpatient Order Requirements
Versalus Health’s Comments on CMS’ Elimination of Burdensome Inpatient Order RequirementsIn the FY 2019 IPPS Final Rule (CMS-1694-F), which is scheduled to be printed in the Federal Register on 8/17/18, CMS finalized its proposal to remove the requirement that a...
Press Release: New VISION Technology by CorroHealth Empowers CDI and HIM Teams to Optimize Compliant Revenue Integrity for Hospitals
CorroHealth recently launched its latest Clinical Documentation Integrity (CDI)-focused solution, VISION, cutting-edge DRG revenue integrity technology
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Regulatory Compliance
Regulatory compliance is a complex issue for many healthcare facilities, especially as new, updated regulations supersede old ones. Hospitals and health systems may find it challenging to stay up to date with regulatory changes impacting Utilization Management (UM) and the clinical revenue cycle and determine the implications of these regulatory changes on the organization’s processes. Fortunately, Versalus Health can assist your organization with keeping up to date with regulatory changes. We keep our finger on the pulse of regulatory oversight, helping facilities understand the newest regulations, their implications for the Clinical Revenue Cycle , and the latest trends in audits
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Hospital utilization management teams ensure patients get the proper care and services they need in compliance with regulations and payer contracts without overusing resources. At the intersection between clinical decisions, documentation, regulations, payer...