News
- CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in State of Washington
- CMS Proposes New Requirements for Off-Campus Outpatient Departments of a Provider – Submit Comments by August 31
- Regulatory Alignment for Predictable & Immediate Device Coverage Pathway Procedural Notice – Inviting Comment by October 13
- Inpatient Psychiatric Facilities: Download Your 2025 PEPPER
Claims, Pricers & Codes
MLN Matters® Articles
- Inpatient Rehabilitation Facility Prospective Payment System: FY 2027 Web Pricer Update
- Medicare Part A Cost Report Overpayments: Default Recoupment Date Extension
- Medicare Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2027 Update
Publications & Multimedia
News
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in State of Washington
CMS announced additional resources and flexibilities available in response to a public health emergency in Washington state due to emergency conditions resulting from major wildfires, including the Fairview, Autumn Lane, and Old Trails fires near Spokane County beginning August 1, 2026, and continuing. CMS is working closely with Washington state and federal partners to put flexibilities in place to ensure those thousands of residents affected by this natural disaster have access to needed care.
CMS will assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care for those impacted by the Washington state wildfires.
More Information:
- Full news alert
- Emergency Preparedness & Response Operations webpage
- Medicare Claims During Public Health Emergencies webpage
CMS Proposes New Requirements for Off-Campus Outpatient Departments of a Provider – Submit Comments by August 31
CMS issued the CY 2027 Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment Systems proposed rule seeking to codify and implement Section 6225 of the Consolidated Appropriations Act, 2026, which prohibits Medicare payments for services provided by certain off-campus outpatient departments of a provider, effective January 1, 2028, unless certain requirements are met. The statute defines off-campus outpatient departments of a provider to mean provider-based departments that are not located on the campus of the provider or are not within the regulatorily-specified distance from a remote location of a hospital.
To continue receiving payment after January 1, 2028, the statute requires affected providers to take the following actions for each off-campus outpatient department of a provider:
- Obtain and bill under a separate NPI
- Submit an initial attestation demonstrating compliance with provider-based regulations within the prior 2 years of the date of service, as well as a subsequent attestation within a timeframe specified by the Secretary
CMS encourages stakeholders to submit comments electronically at regulations.gov by August 31, 2026.
Regulatory Alignment for Predictable & Immediate Device Coverage Pathway Procedural Notice – Inviting Comment by October 13
CMS issued a proposed procedural notice outlining a faster way for manufacturers to get new devices covered by Medicare: The Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway. First announced by CMS and FDA on April 23, 2026, this new Medicare coverage pathway will accelerate beneficiary access to eligible Class II FDA-designated Breakthrough Devices participating in FDA’s Total Product Life Cycle Advisory Program (TAP) and to eligible Class III FDA-designated Breakthrough Devices (regardless of TAP participation).
More Information:
Inpatient Psychiatric Facilities: Download Your 2025 PEPPER
CMS released the 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for inpatient psychiatric facilities. Your PEPPER helps you review your billing data to make sure claims are accurate. Use it to:
- Spot billing patterns that may need review or improvement
- Identify areas that may need closer monitoring or internal audits
- Find services that may be under‑coded or over‑coded
- Track trends like longer patient stays
How to Get Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal.
How to become an SEU:
- Sign in to the CMS Identity & Access (I&A) System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function for your organization. The Comparative Billing Report business function is also available and you can request it at the same time.
- Your AO or AM must approve your request.
More Information:
- Visit the Training & Resources webpage for more information about the release and the User Guide
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
- Register for a webinar on August 25 at 1 pm ET
Claims, Pricers & Codes
Skilled Nursing Facility Prospective Payment System: FY 2027 Pricer Update
CMS published payment rates effective October 1, 2026, in the FY 2027 Skilled Nursing Facility (SNF) Prospective Payment System final rule.
Effective FY 2023, CMS applies a permanent 5% cap on any decrease to a provider’s wage index from its wage index in the prior year. This cap doesn’t apply to new SNFs for their first full or partial FY because they don’t have a wage index in the prior FY.
More Information:
- Medicare Claims Processing Manual, Chapter 6 (PDF), section 30.5
- Instruction to your Medicare Administrative Contractor (PDF)
MLN Matters® Articles
Inpatient Rehabilitation Facility Prospective Payment System: FY 2027 Web Pricer Update
Learn about updates (PDF), effective October 1, 2026:
- Rural transition policy
- Wage index cap
Medicare Part A Cost Report Overpayments: Default Recoupment Date Extension
Learn about changes (PDF), effective January 4, 2027.
Medicare Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2027 Update
Learn about updates (PDF) for implanted devices replaced at no cost or with a credit.
Publications & Multimedia
Power Mobility Devices
Learn how Medicare Part B covers power mobility devices, including power-operated vehicles and power wheelchairs.
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