Medicare & Medicaid
The American Diabetes Association does not recommend the treatment and Medicare's review of the therapy for diabetic wounds owes more to hospitals' pursuit of revenue than to the treatment's proven value.
State officials are hoping to win a 21-month extension of an agreement that began in 2011 and will expire in December.
Defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient visit, the Department of Justice said.
The groups are praising CMS for suggesting payment rule changes that would allow more flexibility for small, independent and rural practices.
The rule gives physicians a break in electronic health record requirements, a reprieve that does not apply to hospitals.
Virtual groups allow solo physicians, or those in groups of 10 or fewer, to band together for participation in MIPS.
Under the new 1,058-page rule, more clinicians will benefit from an increased low-volume threshold.
That's been beneficial to hospitals, which have seen reductions in uncompensated care and overall improved financial performance, analysis showed.
Systems need to accept the new number by April 2018, but may file claims using a patient's Social Security number during the transition.
Most of that reflects the significant increase in private insurance enrollment during that period, which was greater in those states.