Numerous provisions in the rule address potentially misvalued services, including both valuation of specific procedures and broader policy issues.

Starting on Monday, we will offer a 5-part series analyzing several key provisions of the 2016 Call Letter that could have a significant impact on plans, PBMs, pharmacies, and providers in the coming year.

Earlier this week, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter.

The application of the Medicare Secondary Payer (MSP) law to clinical trial sponsors has long been a point of significant contention between sponsors and CMS, with CMS insisting (via subregulatory guidance, and a widely circulated letter) that clinical trial sponsors are like insurers, and thus subject to the law.

On May 21, 2025, the Centers for Medicare and Medicaid Services ("CMS") announced a significant expansion of...

Earlier this month and with little fanfare, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would invoke CMS's rarely used retroactive-rulemaking...

The Centers for Medicare and Medicaid (CMS) announced on August 24 that the Medicare Shared Savings Program (the MSSP) had the second-highest annual savings...

In regulations published on April 16, 2018, the Centers for Medicare & Medicaid Services (CMS) issued two new documents containing guidance primarily on the Medicare Advantage (MA) ...

On November 12, 2021, the Centers for Medicare and Medicaid Services (CMS) announced that it is rescinding the Medicare Coverage of Innovative Technology and Definition of "Reasonable and Necessary" (MCIT/R&N) final rule, which would have become effective on December 15, 2021.

​Like it or not, the Centers for Medicare & Medicaid Services (CMS) is showing a strong commitment to moving forward with its focus on hospitals' quality and care improvement as the basis for payment.

On October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited proposed rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts beginning January 1, 2017

The Centers for Medicare & Medicaid Services (CMS) has published its proposed Medicare physician fee schedule (PFS) rule for calendar year (CY) 2020

The Centers for Medicare & Medicaid Services ("CMS") issued a proposed rule on federal payment amounts to states that elect to establish a Basic Health Program ("BHP")...

On July 12, 2007, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for the 2008 Physician Fee schedule, and proposed rules on a number of Part B programs including Independent Diagnostics Testing Facilities (IDTFs), Physician Quality Reporting Initiatives (PQRIs), Anemia Quality Indicators, Physician Pathology Services, and the Physician Assistant and Quality Initiative Fund (PAQI).

On November 6, 2017 the Centers for Medicare & Medicaid Services (CMS) issued an information bulletin on changes and improvements to the existing Section 1115 waiver process.

The Centers for Medicare & Medicaid Services (CMS) has issued its proposed Medicare physician fee schedule (PFS) rule for calendar year (CY) 2019.

On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014.

CMS is publishing a major final rule to base Medicare clinical laboratory fee schedule reimbursement on private insurance payment amounts, as required by the Protecting Access to Medicare Act of 2014.

The Centers for Medicare & Medicaid Services (CMS) has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies ...

The threshold for 2014 is $32 per cm2.