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Navigating CMS Updates; Empower Featured Image
Navigating CMS Updates; Empower Featured Image
Every year the Center for Medicare and Medicaid Services (CMS) administers healthcare programs for more than 150 MILLION Americans. While this oversight ensures patients receive the best quality care, many providers face ongoing challenges keeping up with changes.

Keeping up with new and existing guidelines can be daunting and may cause operational disruptions for many healthcare providers and the patients they serve.
When you partner with Empower, you're not in it alone. Your business has a resource to keep you informed and help you stay compliant with regulations so you can focus on what you do best: patient care.

Provider vs. Patient Impacts

Impact on Providers

Changes in reimbursement rates affect the revenue that healthcare providers receive and can influence the willingness to accept government-sponsored plans.

Impact on Patients

Patients may face challenges in accessing adequate care if providers opt-out of government-sponsored plans due to financial constraints.

Impact on Providers

Providers can become misinformed, leading to errors in patient EMRs. These errors can result in denied claims, payment delays, and potential audits.

Impact on Patients

 If a patient receives a bill for a procedure or diagnosis they do not have, due to incorrect coding, they may begin to lose trust in the healthcare company.

Coverage Determination WP Assest

Impact on Providers

If a change in service coverage occurs, providers may not receive payment for delivering it, leading to a financial loss.

Impact on Patients

If a particular treatment or procedure is no longer covered, patients may be have to explore alternative options, bear the full cost themselves, or pursue filling an appeal.

Ways to Navigate CMS Rule Changes

CMS FAQ's

CMS proposes updates on an annual, quarterly, and at times on an ad-hoc basis, in response to urgent healthcare needs or changes in legislation.

Healthcare providers should aim to implement changes from CMS updates as soon as possible to remain compliant.

Healthcare providers that fail to comply with CMS updates may face several penalties that include possible reduction in their annual payment.

While most benefits are consistent throughout the United States, there are state-specific rules that may impact certain aspects of Medicare/Medicaid coverage, including annual birthday rules, guaranteed issue rights, and excess charges.

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