A key objective is to enable updates to the MS-DRG payment rates that are no longer dependent on gross charges billed by hospitals that are reduced to cost using hospitals' cost report data. Included ...

Connolly Healthcare, the Recovery Audit Contractor (RAC) for 17 states, posted 35 new issues and removed four older issues on its “approved issues” Web page last week. The postings continued a pattern ...

If additional procedure codes describing CAR T-cell therapies are approved and finalized, CMS will assign them to the most appropriate MS-DRG. Q: CMS created a new MS-DRG for chimeric antigen receptor ...

On November 30, CMS’s Center for Medicare & Medicaid Innovation (CMMI) announced its preliminary list of 48 clinical episodes (and included MS-DRGs) it will test in Models 2 through 4 of its Bundled ...

Last Friday (November 21), the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2026 Outpatient Prospective Payment ...

The sky is no longer falling. It has fallen, period. Analysis of the newly posted issues from Connolly Healthcare and HDI (Health Data Insights) reveals that for first time Rehabilitation Facilities ...

The process of bundled payments — in which hospitals, physicians, post-acute care providers and other receive a lump sum to cover a specific episode of care over an allotted period of time — is still ...

Diagnostic-related groups (DRGs) are how Medicare and some other health insurance companies categorize hospital costs to determine how much to pay for a hospital stay. With DRGs, the payment amount ...

In the complicated world of hospital billing, there’s a fine line between maximizing reimbursement and gaming the system. A new study shows a troubling trend as hospitals increasingly code for “sicker ...

Hospitals decide how much to bill Medicare for your care based on your diagnostic-related group (DRG). They then charge Medicare based on your DRG tier instead of separately for each of your medical ...