Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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N.J. health commissioner report pushes for full financial transparency for all hospitals

A report released late Friday by New Jersey’s health commissioner, Mary O’Dowd, recommends that the state require that all hospitals, public and private, for-profit and non-profit, publish their quarterly unaudited financial statements on their websites within 45 days of each quarter’s end, and their annual audits within 180 days of the close of a hospital’s fiscal year.

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Sunshine rule off to rocky start as doctors encounter error messages on reporting site

Physicians attempting to log in to the Open Payments website to verify information reported about them ahead of that information being made public are encountering a cumbersome log-in process and confusing error messages, reports ProPublica.

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AHA and hospitals seek summary judgment in claim denial appeals backlog case

Noting that by their estimates, billions in disputed claims are tied up in the current appeals process for denied Medicare claims and this is causing severe harm to hospitals, the American Hospital Association along with the hospital operators Baxter Regional Medical Center, Covenant Health, and Rutland Regional Medical Center, have asked a Washington, D.C., court to issue a summary judgment in their favor and compel the U.S. Department of Health and Human Services (HHS) to honor the law’s requirement that disputed claims be heard by an Administrative Law Judge (ALJ) within 90 days.

ICD-10 guidance calls for dual coding during transition

A final rule regarding the new ICD-10 implementation date is coming from the Centers for Medicare & Medicd Services but new guidance indicates the need for dual coding.

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Proposed MPFS seeks to boost payments to primary care

The Centers for Medicare & Medicaid Services (CMS) used the proposed 2015 Medicare Physician Fee Schedule (MPFS) to create some carrots and sticks to encourage moving the care of more patients, particularly the growing percentage of beneficiaries with multiple chronic illnesses, into the lower-cost outpatient primary care setting.

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CMS releases proposed 2015 hospital OPPS and ASC rates

The Centers for Medicare and Medicaid Services (CMS) has proposed a 2.1 percent market basket update for services paid under the hospital Outpatient Prospective Payment System (OPPS) in 2015 and to update Ambulatory Surgery Center (ASC) payments by 1.2 percent next year.

Bill introduced in House and Senate to further quality reporting in post-acute care

Leaders from the Senate Finance Committee and House Ways and Means Committee have introduced the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which would set quality standards and mandatory reporting deadlines for post-acute care provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies.

ICD-10 survey: Providers prepared, but worried about productivity, revenue

The majority of healthcare organizations are prepared to begin ICD-10 testing in the near future, however concerns persist about the impact of ICD-10 on work, productivity and revenue, according to a joint survey from the eHealth Initiative and the American Health Information Management Association.

Around the web

The tirzepatide shortage that first began in 2022 has been resolved. Drug companies distributing compounded versions of the popular drug now have two to three more months to distribute their remaining supply.

The 24 members of the House Task Force on AI—12 reps from each party—have posted a 253-page report detailing their bipartisan vision for encouraging innovation while minimizing risks. 

Merck sent Hansoh Pharma, a Chinese biopharmaceutical company, an upfront payment of $112 million to license a new investigational GLP-1 receptor agonist. There could be many more payments to come if certain milestones are met.