Payment Rules

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Regulatory

Physician and Facility Payment Rules

The Centers for Medicare & Medicaid Services (CMS) publishes rules to establish or modify the way the agency administers its programs, including Medicare Physician Fee Schedule rule, Inpatient Prospective Payment (IPPS) rule, Outpatient Prospective Payment System (OPPS) rule, Medicare Advantage and Part D rules, and the No Surprises Act.

Regulatory

Medicare Physician Fee Schedule Rule

The Medicare Physician Fee Schedule Rule lists payment rates for more than 12,600 unique covered services.

Regulatory

Inpatient Prospective Payment System Rule

The Inpatient Prospective Payment System rule is the rule for Medicare payment for acute care hospital inpatient stays.

Regulatory

Outpatient Prospective Payment System

The Outpatient Prospective Payment System rule is the Medicare payment rule for outpatient services provided in hospitals.

Advocacy

Medicare Advantage and Part D Rules

The rules set by the CMS that insurance companies must follow in administering Medicare Advantage and Part D plans.

Regulatory

No Surprises Act

In December 2020, Congress passed the No Surprises Act (NSA), which partially went into effect at the beginning of 2022.