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Medicare payment rules

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The Centers for Medicare & Medicaid Services (CMS) publishes regulations—also known as “rules”—to establish or modify the way the agency administers its programs. CMS rules may impact providers or suppliers of covered services or the individuals enrolled or entitled to benefits under CMS programs. 

Much of the regulatory activity is focused on physician and facility reimbursement rules, including the: 

  • Medicare Physician Fee Schedule (MPFS) Rule 
  • Inpatient Prospective Payment System (IPPS) Rule 
  • Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Payment System Rule 
  • Medicare Advantage and Part D Rules