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Old billing habits die hard, which can be costly! Hospitals that still rely on series billing may be leaving significant dollars on the table. Nimitt’s latest Spotlight article breaks down why this outdated practice persists; what’s changed under OPPS; and how updating systems to per-day billing can improve reimbursement, reduce payment delays, and ease administrative burden. Read the full article here

Most payers are legally required to cover routine costs related to clinical trial treatment. In this article, Nimitt recommends that hospitals familiarize themselves with these requirements, which will support reimbursement and access to clinical trials that is timely and equitable. Read the full article here.

Four new AMA-approved CPT® codes for CAR-T cell collection, cell processing (outbound and inbound), and administration (3X018-3X021) go into effect on 1/1/2025. Nimitt created this article to help providers advocate for CMS to MPFS recognition of separate payment for CAR-T cell collection and cell processing services provided in both the hospital setting and free-standing physician offices. Read the full article here.

Four new AMA-approved CPT® codes for CAR-T cell collection, cell processing (outbound and inbound), and administration (3X018-3X021) go into effect on 1/1 2025. Nimitt created this article to help providers advocate for CMS to provide hospitals with OPPS payment for outpatient CAR-T cell collection and cell processing services to ensure appropriate payment is provided to hospitals for the clinical services provided to patients. Read the full article here.

Most Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, but MA claims are not used in Medicare rate-setting. It is imperative for stakeholders to have access to MA data along with Medicare fee-for-service (FFS) data to improve the rate-setting process. Nimitt created this article to help providers advocate for access to MA claims data and encourage CMS to study the impact of MA claims’ exclusion on FFS rate-setting. Read the full article here.

CMS’ new Cell and Gene Therapy (CGT) Access Model seeks to test whether outcomes-based agreements improve access to transformative CGTs for beneficiaries with sickle cell disease. In this article, Nimitt discusses the need for CMS to address challenges created by Medicaid out-of-state provider enrollment regulations, which present often-insurmountable barriers to care. Read the full article here.

In the 2024 MPFS final rule, CMS created four new codes and payments for services designed to improve patient health: social determinants of health, principal illness navigation, community health integration, and caregiver training services. In this article, Nimitt summarizes the codes, their use, payment rates, and raises some key implementation questions. Read the full article here.

Site neutral payment policies do not achieve the goal of addressing the nation’s astronomical health care costs. Instead, they will harm patients and providers alike and exacerbate hospital closures, particularly in rural and urban areas with reduced access to facilities. Nimitt wrote this article to highlight these policies’ problematic results and present viable alternatives. Read the full article here.