Every year the Center for Medicare and Medicaid Services (CMS) administers healthcare programs for more than 150 MILLION Americans. While this poses as a benefit for most, many healthcare providers face ongoing challenges related to the frequent rule changes mandated by CMS.

Often times, keeping up with new regulations and guidelines can be daunting and may cause operational disruptions for many healthcare providers and the patients they serve. Explore how partnering with Empower can help you and your healthcare business stay informed and navigate these regulatory changes.

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 the 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 EMR’s. These errors can result in denied claims, payment delays, and potential audits.

Impact on Patients

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

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 forced to explore alternative options, bear the full cost themselves, or undertake the arduous process of filing a complex and time-consuming appeal.

Ways to Navigate CMS Rule Changes


CMS proposes updates on an annually, 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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