Health Law Highlights

CMS Releases Proposed Rule on Anomalous DME Spending and MSSP Financial Calculations

Summary of article from American Hospital Association:

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule to address significant, anomalous, and highly suspect (SAHS) billing activity affecting the Medicare Shared Savings Program (MSSP) financial calculations for 2023. CMS proposes excluding payment amounts for certain intermittent urinary catheter codes from expenditure and revenue calculations for 2023, impacting benchmarks for subsequent years and application cycles for new agreements starting in 2025. This decision follows advocacy from the AHA and others to relieve accountable care organizations (ACOs) from the financial burden of anomalous spending beyond their control. CMS has initiated a 30-day comment period, ending July 29, to ensure minimal disruption to ACO timelines. The AHA supports this move and anticipates further measures in the upcoming CY 2025 Physician Fee Schedule to address anomalous spending comprehensively.