CMS Releases Final Medicare Reimbursement Rules for 2025
Among the many new rules are physician reimbursement cuts of 2.9%, and hospital outpatient department boosts of 2.9%. Congress braces for a post-election lobbying fight. In other Medicare news: rural health care, star ratings, and more.
Modern Healthcare:
Medicare Physician Pay Cut Finalized For 2025
The Centers for Medicare and Medicaid Services has gone ahead with a 2.9% cut to Medicare physician reimbursements for 2025, setting up a lobbying fight when Congress gets back to Washington after the elections. CMS published the Medicare Physician Fee Schedule final rule Friday, which retains the payment reduction the agency proposed in July. The American Medical Association and other physician societies are pleading with Congress to stop the cut from taking effect or blunt its impact— as it did for 2024 and prior years. (Early, 11/1)
Modern Healthcare:
Outpatient Hospitals To Get 2.9% Medicare Pay Bump In 2025
Hospital outpatient departments and ambulatory surgical centers will receive a 2.9% Medicare pay boost next year under a final rule the Centers for Medicare and Medicaid Services issued Friday. The reimbursement increase is up from the 2.6% hike CMS proposed in July. The hospital outpatient payment update reflects a 3.4% hospital market basket increase offset by a -0.5% productivity adjustment. (Kacik, 11/1)
Modern Healthcare:
Medicare Pay Bumps Given To Home Health, ESRD Providers In 2025
Home health and dialysis providers will get modest Medicare reimbursement increases in 2025 under final rules the Centers for Medicare and Medicaid Services issued Friday. Medicare home health payments will rise 0.5% next year after the agency proposed a 1.7% cut in June. Dialysis providers treating end-stage renal disease patients are set for a 2.7% reimbursement hike, higher than the 2.2% CMS proposed in June. (Young, 11/1)
Stat:
Key Senators Propose Using ‘Site-Neutral’ Pay To Boost Rural Hospitals
The hospital industry has pushed back against Medicare payment reforms for years, arguing that the policies would financially hurt rural hospitals. Two key senators on Friday released a plan to get around that issue by reinvesting some of the money saved from payment reforms to help rural and safety-net hospitals. Hospitals that keep providing services like trauma centers, labor and delivery units, and burn units would get financial bonuses, too. (Zhang, 11/1)
Modern Healthcare:
Rural Home Care Deserts Caused By Low Medicare Pay, Providers Say
Home health deserts are increasing at an alarming rate across some rural states as home health companies close or reduce services due to financial challenges. Home health companies in Maine, Nebraska and Minnesota say a proposed Medicare rate cut, low Medicare Advantage reimbursements and workforce shortages are forcing them to make difficult business decisions — leaving many communities with limited access or no access to post-acute care in the home. (Eastabrook, 11/1)
Modern Healthcare:
Elevance Sues Over Medicare Advantage Star Ratings
Elevance Health is the latest Medicare Advantage insurer to dispute its star ratings quality scores in court. The health insurance company filed suit against the federal government in the U.S. District Court for the Northern District of Texas on Thursday. According to Elevance Health, the Centers for Medicare and Medicaid Services improperly assessed its quality performance, costing the insurer $375 million in bonus payments. The company won a case regarding its 2024 star ratings on different grounds, which led the agency to recalculate scores across the program. (Tepper, 11/1)
KFF Health News:
Election Outcome Could Bring Big Changes To Medicare
On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential candidate accuses the other of backing spending cuts and other policies that would damage the health insurance program for older Americans. But the election’s outcome could alter the very nature of the nearly 60-year-old federal program. (Armour, 11/4)
