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CY 2026 OPPS and ASC Final Rule: Medicare Payment Updates for Hospitals and ASCs
CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (CMS-1834-FC) December 2025 Overview On November 21, 2025, CMS issued sweeping reforms in the CY 2026 Hospital Outpatient Prospective Payment System (OPPS)...
Regulatory Bulletin: November 2025 WISeR Model
WISeR (Wasteful and Inappropriate Service Reduction) Model November 2025 Overview CMS has the responsibility to protect the Medicare Trust Funds, and routinely analyzes data associated with all facets of the Medicare program. A 2020 analysis of claims submitted by...
CMS Final Rule 2026: IPPS & LTCH PPS Updates (CMS-1833-F)
CMS Fiscal Year 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule CMS-1833-F Overview On July 31, 2025 CMS released the Fiscal Year 2026 Hospital Inpatient Prospective Payment System...
CMS Transitions Short Stay Inpatient Reviews From the QIO to the TPE MACs
CMS Transitions Short Stay Inpatient Reviews From the QIO to the TPE MACs September 1, 2025 Overview On May 22, 2025, CMS announced that the short stay inpatient hospital medical reviews will be transitioning from The Beneficiary and Family Centered Care (BFCC)...
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…
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...
CY 2026 OPPS and ASC Final Rule: Medicare Payment Updates for Hospitals and ASCs