Prepare for CMS’s new Medicare prior authorization model

On June 29, 2025, CMS announced the Wasteful and Inappropriate Service Reduction (WISeR) Model, a new payment model under the Center for Medicare and Medicaid Innovation targeting waste, fraud and abuse in Medicare fee-for-service. Unlike Medicare Advantage, Medicare fee-for-service has not previously implemented [...]

2025-07-11T09:34:30-05:00July 11th, 2025|Payer Advocacy|

CMS publishes national coverage memo on noninvasive ventilation in the home for chronic respiratory failure due to COPD

On June 9, 2025, the Centers for Medicare & Medicaid Services (CMS) published a national coverage determination (NCD) memo for noninvasive positive pressure ventilation (NIPPV) in the home for chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD). This decision introduces [...]

2025-06-27T14:40:28-05:00June 27th, 2025|Coding, Payer Advocacy|

Support for clinicians impacted by California wildfires

On Feb. 3, the Centers for Medicare & Medicaid Services (CMS) announced that the “Extreme and Uncontrollable Circumstances Exception” policy will be applied to Merit-based Incentive Payment System (MIPS) eligible clinicians who have been impacted by the wildfires in California. Performance categories for [...]

2025-02-06T16:13:45-06:00February 6th, 2025|Payer Advocacy|

CMS accepting MIPS submissions through March 31

On Jan. 3, the Centers for Medicare & Medicaid Services (CMS) announced that Merit-Based Incentive Payment System (MIPS) submissions for the Quality Payment Program (QPP) can now be submitted and updated through 8 p.m. ET on March 31, 2025. The AASM has developed the [...]

2025-01-23T23:37:43-06:00January 23rd, 2025|Payer Advocacy|

CMS updates guidance on code G2211

The Centers for Medicare & Medicaid Services (CMS) has posted the revised resource, “How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-On Code G2211.” The code G2211 reflects visit complexity and increases the value of office and outpatient evaluation and [...]

2025-01-09T20:35:07-06:00January 9th, 2025|Payer Advocacy|
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