Skip to Main Content

insightsArticles

Gain perspectivesThought leadership

Professionals

Read this if you are interested in learning about ESG. 

Although tax credits as subsidies have been a cornerstone catalyst for advancing many environmental, social, and governance (ESG) policies and technologies over the last several years, tax is often forgotten or minimized in the process of creating and implementing corporate ESG and value creation strategies. Ignoring the symbiotic relationship between tax and ESG is a losing strategy, given increased awareness of the importance of tax transparency among shareholders and other stakeholders as a mechanism for holding companies accountable to their stated ESG commitments. A rise in media and rating agency reports on the topic indicate tax will continue to be under scrutiny in the future and may increasingly have significant corporate reputational impacts as well.

As leaders of an organization’s tax function, including as vice presidents of tax, tax directors, or CFOs among others, you are the stewards charged with ensuring tax strategy and operations appropriately intersect with the corporate ESG vision and meaningfully advance ESG commitments. However, the 2022 BDO Tax Outlook Survey found that while an overwhelming majority of senior tax executives expressed an understanding of the value of ESG, three quarters of those responsible for tax were not currently involved in the organization’s ESG strategy. The findings indicate that tax leaders will need to insert the tax function into the ESG planning and execution process and take ownership of tax’s role in ESG. Insights from the survey outline how tax fits into ESG, the core principles of an ESG-focused tax strategy and key considerations for transparent reporting.

How does tax overlap with ESG?

Because there is some misunderstanding about how tax relates to environmental, social, and governance issues, there is a high probability that tax may not be incorporated in responsible business strategy and planning. While not reflected in the ESG acronym, there is an element of tax that is central to each of these principles. For example, environmental behavioral taxes and incentives, such as carbon taxes on greenhouse gas emissions and tax incentives for green energy adoption, are crucial to driving behavior change toward more sustainable practices in the near term while many impacts of climate change are still experienced in indirect ways. In terms of the social element, taxes are a key mechanism for companies to contribute to the societies in which they operate and to build trust among members of the public as a responsible corporate actor. Finally, proper tax governance can ensure that there is appropriate oversight over an organization’s tax strategy and decisions, ensuring they align with overarching business objectives and stakeholder communications around tax reporting.

Using the tax ESG cipher to unlock a successful ESG-driven tax strategy

Aligning the tax function with an overarching ESG strategy across the business is a heavy lift. To build and implement a responsible tax program will take time and requires careful consideration of an organization’s overall approach to tax, tax governance and total tax contribution. Each company will have a unique tax strategy based on its business and stakeholder considerations and may be at varying points along its responsible tax journey. Whether you are just beginning or at the stage of reassessing your approach based on changing market conditions, updates to your ESG strategy, or regulations, the cypher below can be used to guide these critical considerations and help ensure tax is meaningfully incorporated in ESG strategy. The process should be iterative over time and when implemented successfully, will drive improved decision-making on risk mitigation, strengthen risk awareness and increase transparency and accountability.

Core principle one: Approach to tax

The first step to meaningfully incorporating tax in ESG strategy is understanding and articulating the purpose and values that guide the tax function. This process includes defining the organization’s approach to regulatory compliance and the interaction with tax authorities. Writing a tax policy and strategy is an important way to articulate the company’s tax priorities and educate all team members across the organization about the function’s principles. The statement may include commitments to communicate transparently with regulators and disclose more information than required by law in some cases, for example.

As the organization evolves due to changes in the industry, overall ESG commitments and sustainability strategies, the tax strategy statement should be updated accordingly. Regulatory changes will also necessitate continuous assessment and consideration of whether the strategy meets the current understandings of transparency, risk mitigation and accountability based on new information. Through this set of guiding principles, the tax function can help improve decision-making and reporting actions to align with changes in the broader corporate ESG strategy, purpose, and values. 

Core principle two: Tax governance and risk management

Establishing a robust governance, control, and risk management framework provides comfort and assurance that the reported approach to tax and tax strategy is well embedded in an organization’s substantiable business strategy and that there are mechanisms in place to effectively monitor its compliance obligations.

However, it’s important to remember that tax governance and risk management have broad considerations that go beyond the traditional frameworks governing internal controls over financial reporting (ICFR). A common pitfall for many is a narrow focus on governance strategies. Generally, ICFR focuses on accurate and complete reporting in financial statements. While this is an important area of governance, it does not account for or represent the many objectives included in a tax ESG control framework, which is typically broader as it focuses on how and why decisions regarding tax approaches and positions are made.

The objective of this core principle is to demonstrate to stakeholders how the organization’s tax governance, control and risk management function are in alignment with the values and principles outlined in the Approach to Tax statement. This can include establishing a risk advisory council, guidelines for including tax in ESG reporting deliverables and any corresponding regulatory requirements, and communications to relevant stakeholders on executive oversight activities related to the tax strategy.  

However, many organizations have not taken the time to document and define their risk mitigation and executive oversight strategy. Often this is left merely to control procedures that are mechanical and regulatory in nature. Instead, a tax governance and risk management strategy should aim to establish a framework focused on strengthening risk awareness and transparently communicating governance activities to both internal and external audiences when appropriate.

Core principle three: Total tax contribution

While quantifying and providing necessary qualitative context around an organization’s total tax contribution is not an easy task, today, stakeholders from employees and customers to investors and regulators expect transparency around tax strategies, tax-related risks, total tax contribution and country-by-country activities. Recently, tax has received increased scrutiny from these stakeholders because it is a core component of many ESG metrics used to evaluate a business’s tax behaviors and ensure there is accountability across its tax practices. The result is that how a company shares tax information with stakeholders and what it includes in reports has a significant impact on reputation and perceptions of corporate ESG statements.

However, the increased demand for tax transparency is not without its challenges. Nearly two-thirds of respondents in the 2022 BDO Tax Outlook Survey (62%) said data collection and analysis (the quantitative component of ESG-focused tax) is the greatest challenge of tax transparency reporting efforts, pointing to an underlying issue of tax data governance and fragmented systems. Often this is an area where tax leaders require outside assistance to establish automated processes that can collect tax data on a periodic basis for regular analysis. The importance of ESG and attention around the topic will only continue to increase over the next several years, so it is critical to begin thinking about adequate data collection and analytic capabilities for tax leaders looking to incorporate tax in ESG practices and strategy. For those just beginning the process, our advice is to partner with in-house IT functions or external consultants for assistance and support.

Collecting relevant tax data on a regular basis is a critical early step because it affords tax leaders the opportunity to determine which information will be disclosed to various stakeholders and which information can help shape and support broader ESG narratives being developed by corporate leadership. While determining data collection processes, it is also important to consider and seek counsel on communication and information delivery strategies that will best reach and address the concerns of priority stakeholder groups.   

Although this task can be a heavy lift, it may also result in significant business advantages. A key benefit is that the data and information gathered will help tax leaders further define and evolve ESG-driven tax strategies through tax monetization structures and company core value items, among others. Ultimately, organizations that better understand their total tax contribution across various taxing jurisdictions and country-by-country activities are best equipped to make data-driven tax strategy decisions that are aligned with broader ESG and sustainability objectives, while also avoiding value creation hinderances. 

Key reporting considerations

Once the quantitative data have been collected, the next step is to consider how you report the information. Communicating the numbers themselves is not enough. Communicating the narrative behind the numbers – the qualitative component of reporting – is extremely important. The narrative should always aim to communicate the company’s approach to tax, values guiding decision-making and the impact of the tax strategy to key stakeholders in a straightforward and transparent manner. However, qualitative reporting can vary by organization depending on several factors, from choice of standards to company philosophy.

The 2022 BDO Tax Outlook Survey also found that challenges and variance in tax transparency reporting are driven by a lack of universal reporting standards and clarity around which ESG frameworks to follow. In the meantime, the best reporting framework for any company is one that drives a deep understanding of the organization’s ESG philosophy and vision, which may require more investment in terms of time and effort. When determining a reporting approach, it is important to consider the goal of the report or disclosure and which data best demonstrate ESG progress and strategy. Because the ESG-related tax reporting is not a mandated process and is currently a voluntary disclosure in the U.S., it can often be helpful to review tax reports related to ESG from other companies already making these disclosures as a baseline.

Keep in mind that one of the main reasons businesses are electing to publish comprehensive ESG and Sustainability Tax Reports and Global Tax Footprints is to articulate their broader total tax contribution to ensure that the tax narrative speaks to the needs and demands of their stakeholders. Each report must be unique and relevant to the company in terms of content and method of disclosure.

Currently, there is a relatively small number of companies electing to make such disclosures, based on the findings of the 2022 BDO Tax Outlook Survey outlined below. Of the 150 senior tax executives polled, less than a quarter (23%) are implementing both qualitative and quantitative disclosures:

Tax transparency reporting disclosures

Today, tax is an essential component of the ESG metrics that determine how stakeholders perceive an organization. Despite this fact, the movement to incorporate tax in ESG planning and strategies is still in its infancy. This means leaders of tax functions still have time to begin the process of implementing ESG-driven tax strategies and operations to ensure the function evolves with the importance of ESG. While there is no simple one-size-fits-all solution, given the nuances and complications of the tax function for each organization, the general framework in the Tax ESG Cipher can help guide tax leaders at any point on the journey. The cipher outlines key considerations to ensure an organization’s ESG vision is well-structured and appropriately includes tax strategies. While the process requires long-term effort and dedication, it generates high returns in terms of accountability, transparency, and reputational and sustainable value.

As ESG takes center stage in a rapidly changing business landscape, how is your organization advancing toward true sustainability?

Written by Daniel Fuller and Jonathon Geisen. Copyright © 2022 BDO USA, LLP. All rights reserved. www.bdo.com  

Article
Navigating the intersection of tax and ESG

Read this if you file taxes with the IRS for yourself or other individuals.

To protect yourself from identity thieves filing fraudulent tax returns in your name, the IRS recommends using Identity Protection PINs. Available to anyone who can verify their identity online, by phone, or in person, these PINs provide extra security against tax fraud related to stolen social security numbers of Tax ID numbers.

According to the Security Summit—a group of experts from the IRS, state tax agencies, and the US tax industry—the IP PIN is the number one security tool currently available to taxpayers from the IRS.

The simplest way to obtain a PIN is on the IRS website’s Get an IP PIN page. There, you can create an account or log in to your existing IRS account and verify your identity by uploading an identity document such as a driver’s license, state ID, or passport. Then, you must take a “selfie” with your phone or your computer’s webcam as the final step in the verification process.

Important things to know about the IRS IP PIN:

  • You must set up the IP PIN yourself; your tax professional cannot set one up on your behalf.
  • Once set up, you should only share the PIN with your trusted tax prep provider.
  • The IP PIN is valid for one calendar year; you must obtain a new IP PIN each year.
  • The IRS will never call, email or text a request for the IP PIN.
  • The 6-digit IP PIN should be entered onto your electronic tax return when prompted by the software product or onto a paper return next to the signature line.

If you cannot verify your identity online, you have options:

  • Taxpayers with an income of $72,000 or less who are unable to verify their identity online can obtain an IP PIN for the next filing season by filing Form 15227. The IRS will validate the taxpayer’s identity through a phone call.
  • Those with an income more than $72,000, or any taxpayer who cannot verify their identity online or by phone, can make an appointment at a Taxpayer Assistance Center and bring a photo ID and an additional identity document to validate their identity. They’ll then receive the IP PIN by US mail within three weeks.
  • For more information about IRS Identity Protection PINs and to get your IP PIN online, visit the IRS website.

If you have questions about your specific situation, please contact our Tax Consulting and Compliance team. We’re here to help.

Article
The IRS Identity Protection PIN: What is it and why do you need one?

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for FY 2023 SNF PPS which was published in the Federal Register on August 3, 2022. The rule:

  • Updates the PPS rates for SNFs for FY 2023 using the market basket update and budget neutrality factors effective October 1, 2022;
  • Recalibrates the Patient Driven Payment Model (PDPM) parity adjustment;
  • Establishes a permanent 5% cap on annual wage index decreases;
  • Finalizes proposed changes in PDPM International Classification of Diseases, Version 10 (ICD-10) code mappings;
  • Updates the SNF Quality Reporting Program (SNF QRP); and
  • Updates the SNF Value-Based Purchasing (SNF VBP) Program.

2023 PPS rate calculations

The final rule provides a net market basket increase for SNFs of 5.1 percent beginning October 1, 2022 which reflects:

  • An unadjusted market basket increase of 3.9 percent adjusted upward by 1.5 percent associated with a forecast error adjustment;
  • A reduction of 0.3 percentage points in accordance with the multifactor productivity adjustment required by Section 3401(b) of the Affordable Care Act (ACA).

In addition, as discussed in the Recalibration of the PDPM parity adjustment section below, the net market basket increase of 5.1 percent is further reduced by 2.3 percent related to accounting for year one of a two-year PDPM parity adjustment phase-in.

CMS projects an overall increase in Medicare Part A SNF payments of approximately 2.7 percent or $904 million in FY 2023 related to the payment rate updates. The final rule also estimates an increase in costs to SNFs of $31 million related to the FY 2023 SNF QRP changes and an estimated reduction of $186 million in aggregate payments to SNFs during FY 2023 as a result of the changes to the SNF VBP program.

The projected overall impact to providers in urban and rural areas is an average increase of 2.7% and 2.5%, respectively, with a low of 1.4% for urban outlying providers and a high of 3.6% for urban Pacific providers―actual impact will vary. 

The applicable wage index continues to be based on the hospital wage data, unadjusted for occupational mix, rural floor, or outmigration adjustment (from FY 2019) in the absence of SNF specific data.

Recalibration of the PDPM parity adjustment

When CMS finalized PDPM in October 2019 it also finalized that this new case-mix classification model would be implemented in a budget neutral manner. However, since PDPM implementation, CMS has closely monitored SNF utilization data which has indicated an unintended increase in payments to providers. In order to achieve budget neutrality under PDPM, CMS is finalizing their proposal to recalibrate the PDPM parity adjustment using a factor of 4.6 percent (an impact of $1.5 billion) using the combined methodology of a subset population that excludes patients whose stay utilized a coronavirus (COVID-19) public health emergency (PHE)-related waiver or who were diagnosed with COVID-19 and control period data using months with low COVID-19. CMS is finalizing the implementation of the parity adjustment with a two-year phase-in period (2.3 percent applied in FY 2023, and 2.3 percent in FY 2024), which means that, for each of the PDPM case-mix adjusted components, CMS will lower the PDPM parity adjustment factor from 46 percent to 42 percent in FY 2023 and would further lower the PDPM parity adjustment factor from 42 percent to 38 percent in FY 2024. CMS applied the parity adjustment equally across all components.

Permanent cap on wage index decreases

To mitigate instability in SNF PPS payments due to significant wage index decreases that may affect providers in any given year, CMS is finalizing a permanent 5% cap on annual wage index decreases to smooth year-to-year changes in providers’ wage index payments.

Changes in PDPM ICD-10 code mappings

Beginning with the updates for FY 2020 nonsubstantive changes to the ICD-10 codes included on the PDPM code mappings and lists are applied through a subregulatory process consisting of posting updated code mappings and lists on the PDPM website. Substantive changes will be proposed through notice and comment rulemaking. The final rule finalized several proposed changes to the PDPM ICD-10 mappings.

SNF QRP update

CMS is finalizing the adoption of a new process measure, the Centers for Disease Control and Prevention (CDC)-developed Influenza Vaccination Coverage Among Healthcare Personnel (HCP) (NQF#0431) measure, beginning with the FY 2024 SNF QRP. The measure is intended to increase influenza vaccination coverage in SNFs, promote patient safety, and increase the transparency of quality of care in the SNF setting. Residents of long-term care facilities have greater susceptibility for acquiring influenza. Therefore, monitoring and reporting influenza vaccination rates among HCP is important as HCP are at risk for acquiring influenza from residents and exposing residents to influenza. The measure reports the percentage of HCP who receive an influenza vaccine. SNFs will submit the measure data through the CDC National Healthcare Safety Network.

CMS is also revising the compliance date for certain SNF QRP reporting requirements, including the Transfer of Health Information measures and certain standardized patient assessment data elements to October 1, 2023. This will align the collection of data with the Inpatient Rehabilitation Facilities and Long-Term Care Hospitals and Home Health Agencies.

SNF VBP program

The rule finalizes a proposal to suppress the SNF 30-Day All-Cause Readmission Measure (SNFRM) as part of the performance scoring for the FY 2023 SNF VBP program year due to the combination of fewer admissions to SNFs, regional differences in the prevalence of COVID-19 throughout the PHE and changes in hospitalization patterns in FY 2021 which has impacted the ability to use the SNFRM to calculate payments for the FY 2023 program year. For FY 2023, CMS will assign a performance score of zero to all participating SNFs and will reduce the otherwise applicable adjusted Federal per diem rate for each SNF by 2% and award SNFs 60% of that withhold, resulting in a 1.2% payback. Any SNFs that do not report a minimum of 25 stays for the SNFRM will be excluded from the VBP program for FY 2023.

In addition, Section 111(a)(2) of the Consolidated Appropriations Act, 2021 allows the secretary to add up to an additional nine new measures with respect to payments beginning in FY 2023 to the VBP program, which may include measures of functional status, patient safety, care coordination, or patient experience. CMS is using this authority to finalize the adoption of three new measures into the VBP program—two measures in FY 2026 and one measure in FY 2027.

CMS is also finalizing a number of updates to its scoring methodology:

  • Updating the policy for scoring SNFs that do not have sufficient baseline period data beginning with the FY 2026 VBP Program year.
  • Adoption of a measure minimum policy beginning with the FY 2026 SNF VBP program year which will require a two-measure minimum for a SNF to receive a SNF performance score for FY 2026 and a three-measure minimum for FY 2027.
  • Adoption of a case minimum policy for the SNFRM that replaces the Low-Volume Adjustment policy beginning with the FY 2023 program year. 
  • Adoption of a case minimum policy for the SNF HAI, Total Nurse Staffing, and DTS PAC SNF Measures beginning between FY 2026 and FY 2027.

Our experts at BerryDunn have created an interactive rate calculator to assist you with the calculation of your PPS rates for FY 2023. You can access the PPS rate calculator now:

Click to download SNF PPS Rate Calculator

Please note: The rates per our calculator are prior to any FY 2023 VBP adjustment based on the final rule which includes special scoring and payment policies for FY 2023. When CMS releases the final VBP incentive payment multipliers for FY 2023 by facility, we will update the interactive rate calculator as necessary.

If you have any specific questions about the final rule or how it might impact your facility, please contact Ashley Tkowski or Melissa Baez.

Article
Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule

Release Date: August 1, 2022
Federal Register Publication Date: Scheduled for August 10, 2022
Effective Date: October 1, 2022 

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment rates and policies for inpatient hospitals and long-term care hospitals for the fiscal year 2023, as well as other provisions. Following is a summary of the major provisions of this final rule.

IPPS payment rates:

CMS finalized a net increase in FY 2023 Medicare IPPS rates of 4.3% for hospitals that are meaningful users of electronic health records and submit required quality data, up 1.1 percentage points from the 3.2% increase initially proposed. The increase is broken down as follows:

CMS estimates the following impact of the proposed rule on hospital payments, including the impact of reductions to DSH and other payments:


 

LTCH PPS Payment Rates:

CMS finalized a net increase in FY 2023 Medicare LTCH PPS rates of 2.3% for long-term care hospitals, up 1.6 percentage points from the 0.7% increase initially proposed. The payment rate update includes the productivity-adjusted market basket increase of 3.8% for FY 2023 and a projected decrease in high-cost outlier payments. CMS estimates that LTCH PPS payments will increase approximately $71 million as a result of the FY 2023 payment update.

Other major provisions:

  • Rate setting will be based on FY 2021 MedPAR claims data and FY 2020 cost report data, consistent with historical practice, but with modifications to account for the COVID-19 pandemic, including:
    • Calculating MS-DRG relative weights based on the average of two set of weights, one including and one excluding COVID-19 claims
    • Determining outlier fixed-loss amount using charge inflation and Cost to Charge Ratio (CCR) adjustment factors to approximate the increase in costs that will occur from FY 2021 to FY 2023
    • Modifying the outlier fixed-loss amount calculation to factor in certain payment increases for COVID-19
  • 25 technologies are eligible for new technology add-on payments (NTAP) in FY2023, including 8 newly approved technologies, discontinuation of NTAP for those technologies that have been in the market for 3 years, and discontinuation for those technologies that received an extension in FY2022.
  • No new MS-DRGs are established and the implementation of the “three-way split criteria” will be further delayed.
  • Policy modification relating to Medicare Graduate Medical Education (GME) for teaching hospitals that apply for the FTE cap when the Hospital’s weighted FTE count is greater than its FTE cap but would not reduce the weighting factor of residents that are beyond their initial residency period to less than 0.5 for cost reporting periods beginning on or after October 1, 2022.
  • Urban and rural hospitals participating in the same Rural Training Program (RTP) are given the same flexibility as other teaching hospital to share RTP cap slots via an GME affiliation agreement, effective academic year beginning July 1, 2023. 
  • Uncompensated care costs will be distributed based on more than one year of Worksheet S-10 cost report data. Data from the two most recent years of audited data (FY 2018 and FY 2019) will be used to distribute FY 2023 payments and a three-year average would be used for FY 2024 and beyond. 
  • Decreases to a hospital’s wage index from the prior fiscal year will be capped at 5%. This policy will be applied in a budget neutral manner through a national adjustment to the standardized amount.
  • Wage index rural floor will be calculated as it was before FY 2020. Wage data of hospitals that have reclassified from urban to rural will be included in the calculation of the rural floor and wage index for rural areas in the state where the hospital’s county is located. 
  • Expected in Fall 2023, CMS will establish a publicly-reported, public-facing hospital designation on the quality and safety of maternity care for hospitals that report “Yes” to both questions in the Maternal Morbidity Structural Measure in the Hospital Inpatient Quality Reporting (IQR) Program. 
  • CMS finalizes a variety of changes for the Hospital IQR Program, some include:
    • Adopting ten measures and refining two current measures
    • Making changes to the existing Electronic Clinical Quality Measures (eCQM) reporting and submission requirements
    • Removing the zero denominator declaration and case threshold exemptions for hybrid measures
    • Updating eCQM validation requirements for medical record requests
    • Establishing reporting and submission requirements for patient-reported outcome-based performance measures.
  • CMS finalizes a variety of changes to the Medicare Promoting Interoperability Program for eligible Hospitals and Critical Access Hospitals (CAHs).
  • CMS will pause or refine certain measures in the Hospital Readmissions Reduction Program (HRRP), Hospital-Acquired Condition (HAC) Reduction Program, and Hospital Value-Based Purchasing (VBP) Program that would be impacted by circumstances caused by the COVID-19 Public Health Emergency.
  • Implement a five-year extension of the Rural Community Hospital and Frontier Community Health Integration project (FCHIP) demonstrations, as authorized by the Consolidated Appropriations Act of 2021.
  • Revise Conditions of Participation (CoP) for Hospitals and CAHs to continue to report COIVD-19 and seasonal influenza data after the conclusion of the COVID-19 PHE and continue until April 30, 2024, unless ended earlier by the Secretary.

Major Proposed Provisions that were NOT finalized:

  • Proposed regulation governing the calculation of the Medicaid fraction of the Medicare disproportionate share hospital (DSH) that would be explicit as to who is “regarded as eligible” for Medicaid. As proposed, it would include only patients who receive health insurance through a Section 1115 demonstration itself, or who purchase such insurance with the use of premium assistance provided by a Section 1115 demonstration that assists with at least 90% of the cost of health insurance. CMS is not moving forward with this proposal currently but expects to revisit it in future rulemaking.
  • CMS has withdrawn its proposal to establish additional data reporting requirements for Hospitals and CAHs during future PHEs related to epidemics and pandemics.

Sources: 
CMS-1771-F Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation

Article
Medicare Final Rule for FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS)

Read this if you are a business owner or responsible for your company’s accounts.

US businesses have been hit by the perfect storm. As the pandemic continues to disrupt supply chains and plague much of the global economy, the war in Europe further complicates the landscape, disrupting major supplies of energy and other commodities. In the US, price inflation has accelerated the Federal Reserve’s plans to raise interest rates and commence quantitative tightening, making debt more expensive. The stock market has declined sharply, and the prospect of a recession is on the rise. Further, US consumer demand may be cooling despite a strong labor market and low unemployment.

As a result of these and other pressures, many businesses are rethinking their supply chains and countries of operation as they also search for opportunities to free up or preserve cash in the face of uncertain headwinds.

Income tax accounting methods

Adopting or changing income tax accounting methods can provide taxpayers opportunities for timing the recognition of items of taxable income and expense, which determines when cash is needed to pay tax liabilities.

In general, accounting methods either result in the acceleration or deferral of an item or items of taxable income or deductible expense, but they don’t alter the total amount of income or expense that is recognized during the lifetime of a business. As interest rates rise and debt becomes more expensive, many businesses want to preserve their cash. One way to do this is to defer their tax liabilities through their choice of accounting methods.

Some of the more common accounting methods to consider center around the following:

  • Advance payments. Taxpayers may be able to defer recognizing advance payments as taxable income for one year instead of paying the tax when the payments are received.
  • Prepaid and accrued expenses. Some prepaid expenses can be deducted when paid instead of being capitalized. Some accrued expenses can be deducted in the year of accrual as long as they are paid within a certain period of time after year end.
  • Costs incurred to acquire or build certain tangible property. Qualifying costs may be deducted in full in the current year instead of being capitalized and amortized over an extended period. Absent an extension, under current law, the 100% deduction is scheduled to decrease by 20% per year beginning in 2023.  
  • Inventory capitalization. Taxpayers can optimize uniform capitalization methods for direct and indirect costs of inventory, including using or changing to various simplified and non-simplified methods and making certain elections to reduce administrative burden.
  • Inventory valuation. Taxpayers can optimize inventory valuation methods. For example, adopting to (or making changes within) the last-in, first-out (LIFO) method of valuing inventory generally will result in higher cost of goods sold deductions when costs are increasing.
  • Structured lease arrangements. Options exist to maximize tax cash flow related to certain lease arrangements, for example, for taxpayers evaluating a sale vs. lease transaction or structuring a lease arrangement with deferred or advance rents.

Improving cash flow: Revisiting your tax accounting methods

Optimizing tax accounting methods can be a great option for businesses that need cash to make investments in property, people, and technology as they address supply chain disruptions, tight labor markets, and evolving business and consumer landscapes. Moreover, many of the investments that businesses make are ripe for accounting methods opportunities—such as full expensing of capital expenditures in new plant and property to reposition supply chains closer to operations or determining the treatment of investments in new technology enhancements.

For prepared businesses looking to weather the storm, revisiting their tax accounting methods could free up cash for a period of years, which would be useful in the event of a recession that might diminish sales and squeeze profit margins before businesses are able to right-size costs.

While an individual accounting method may or may not materially impact the cash flow of a company, the impact can be magnified as more favorable accounting methods are adopted. Taxpayers should consider engaging in accounting methods planning as part of any acquisition due diligence as well as part of their regular cash flow planning activities.  

Impact of deploying an accounting method

The estimated impact of an accounting method is typically measured by multiplying the deferred or accelerated amount of income or expense by the marginal tax rate of the business or its investors.
For example, assume a business is subject to a marginal tax rate of 30%, considering all of the jurisdictions in which it operates. If the business qualifies and elects to defer the recognition of $10 million of advance payments, this will result in the deferral of $3 million of tax. Although that $3 million may become payable in the following taxable year, if another $10 million of advance payments are received in the following year the business would again be able to defer $3 million of tax.

Continuing this pattern of deferral from one year to the next would not only preserve cash but, due to the time value of money, potentially generate savings in the form of forgone interest expense on debt that the business either didn’t need to borrow or was able to pay down with the freed-up cash. This opportunity becomes increasingly more valuable with rising interest rates, as the ability to pay significant portions of the eventual liability from the accumulation of forgone interest expense can materialize over a relatively short period of time, i.e. the time value of money increases as interest rates rise.

Accounting method changes

Generally, taxpayers wanting to change a tax accounting method must file a Form 3115 Application for Change in Accounting Method with the IRS under one of two procedures:

  • The “automatic” change procedure, which requires the taxpayer to file the Form 3115 with the IRS as well as attach the form to the federal tax return for the year of change; or
  • The “nonautomatic” change procedure, which requires advance IRS consent. The Form 3115 for nonautomatic changes must be filed during the year of change.

In addition, certain planning opportunities may be implemented without a Form 3115 by analyzing the underlying facts.

Next steps for businesses

Taxpayers should keep in mind that tax accounting method changes falling under the automatic change procedure can still be made for the 2021 tax year with the 2021 federal return and can be filed currently for the 2022 tax year.

Nonautomatic procedure change requests for the 2022 tax year are recommended to be filed with the IRS as early as possible before year end to give the IRS sufficient time to review and approve the request by the time the federal income tax return is to be filed.

Engaging in discussions now is the key to successful planning for the current taxable year and beyond. Whether a Form 3115 application is necessary or whether the underlying facts can be addressed to unlock the accounting methods opportunity, the options are best addressed in advance to ensure that a quality and holistic roadmap is designed. Analyzing the opportunity to deploy accounting methods for cash savings begins with a discussion and review of a business’s existing accounting methods.

Please contact our Tax Consulting and Compliance team if you have questions or concerns about your specific situation. We’re here to help.

Article
When interest rates rise, optimizing tax accounting methods can drive cash savings

Read this if you use QuickBooks Online.

QuickBooks Online provides numerous ways for you to know which customers owe you money – and who is late.

There are so many financial details to keep track of when you’re running a small business. You have to make sure your products and services are in good shape and ready to sell. You have to stay current with your bills. Orders need to be processed as quickly as possible, as do estimates and invoices. And you may have numerous questions from customers and vendors that must be addressed.

Your number one priority, however, is ensuring that your customers are paying you. Whether you accept credit cards or bank transfers or issue sales receipts for cash and checks, you need to always know where you stand with incoming payments. “Are my receivables current?” should be a question you’re asking yourself or your staff frequently.

QuickBooks Online offers numerous ways to know whether you’re being paid for your products and/or services and who might be falling behind. That information is critical to your understanding of how your receivables are stacking up against your payables. You should be able to gauge whether you’re making a profit, staying even, or losing money. Here’s a look at the tools you can use.

Learning when you launch

QuickBooks Online provides a good overview of your current cash flow as soon as you log into the site and see your two-pronged Dashboard. The first thing you see when you click the Business overview tab is a cash flow forecast that goes up to 24 months. Other content includes a profit and loss graph and charts showing expenses, income (including open and overdue invoice totals), and sales. Your account balances are there, too.

This is helpful data, but it’s broad. To get far more detailed information, hover your mouse over Sales in the toolbar and select All Sales. The horizontal bar across the top displays dollar and transaction totals for estimates, unbilled activity, overdue (invoices), open invoices, and (invoices) paid last 30 days. When you click one of the bars, the list changes to show only that particular set of transactions.

 Partial view of the toolbar at the top of the Sales Transactions page

The table of transactions is interactive. That is, there’s an Action column at the end of each row. Click the down arrow next to any of the activity listed there, and you’ll see a menu of options. Depending on the status of each, these options include commands like Receive payment, Send reminder, Print packing slip, Send, and Void

Running reports

The Sales Transactions page provides more of your receivables nuts and bolts than the b screen does. But to get the most in-depth, customizable, comprehensive view of who owes you, you’ll need to run reports. Click Reports in the toolbar and scroll down to Who owes you

There are three columns here. You’ll land on Standard, which is a complete list of all of the pre-formatted reports that QuickBooks Online offers. Click Custom reports to see the reports you’ve customized and saved. Management reports opens a list of three reports that can be viewed by a variety of date ranges: Company Overview, Sales Performance, and Expenses Performance. You can view, edit, and send these, as well as export them as PDF and Microsoft Word files.

There are five reports listed under Who owes you that you should be creating on a regular basis. How regularly? That depends on the size of your business. The greater your sales volume, the more frequently you should run them.

When you select A/R Aging Summary, you’ll see at a glance which customers have current balances and those that are 1-30, 31-60, 61-90, and 91+ days past due. A few customization options appear at the top, like Report period, Aging method, and Days per aging period. To really zero in on the precise data set you want, click Customize. The panel that slides out from the right contains option in several areas: General, Rows/Columns, Aging, Filter (by customer), and Header/Footer.

QuickBooks Online helps you target the data set that you want.

There are four other reports that can help you track your receivables:

  • Open Invoices displays a list of invoices that still contain a balance.
  • Unbilled Time tells you about any billable time that hasn’t been invoiced.
  • Unbilled Charges lists billable charges that haven’t been invoice.
  • Customer Balance Summary simply provides all open balances for you customers.

These are all very simple reports that you shouldn’t have any trouble customizing and running. They can give you a complete picture of where your receivables stand. But there are other reports that will require our help. These are standard financial reports that should be created monthly or quarterly, including Statement of Cash Flows, Profit and Loss, and Balance Sheet. You’ll need these critical financial statements if, for example, you’re applying for a loan or trying to attract investors.

Please contact the Outsourced Accounting team if you want us to run and analyze these so you can get a detailed, comprehensive view of your financial health.

Article
Keeping up with receivables: Know who owes you

Read this if you are at a financial institution with employees working remotely.

Working remotely is not a new concept. Over the past 20 years, technology enhancements have increased the ability for employees to connect remotely and perform many job functions without ever leaving their homes. When the COVID-19 pandemic began in early 2020, working remotely became a necessity for essential businesses like financial institutions to provide safe environments for both employees and customers and remain open.

One of the benefits of an increase in working from home during the pandemic is that it provided financial institutions and other businesses an opportunity to learn how to perform essential job functions and manage teams from a distance. In addition, many organizations experienced indirect benefits, including a more flexible work environment, higher job satisfaction, increased productivity, and improved employee retention. Now that employees are being asked to return to the office, many financial institutions are considering if a permanent work-from-home arrangement is possible. 

What you need to know

For starters, financial institutions need to know where their employees are providing services. Is it across state lines or across the country? What if you have two or more employees who want to work out of state—and they are all different states? What are the tax implications? Are there legal concerns?

Nexus

Nexus is the connection that taxpayers have with a state that permits the state to assess various types of taxes, including income tax. Nexus rules vary from state to state, but generally a business with nexus in a state is required to register with the Secretary of State/Department of Revenue, file tax returns, and pay various taxes to the state. 

Employees working in a "different state" (a state which income tax returns are not already being filed) may create nexus to that state for tax purposes. Even if your financial institution has only one employee working in a state and otherwise has no other connection to the state, there may be tax implications. Some states have established nexus waivers because of the pandemic, providing relief to some businesses and employees who have temporary work-from-home arrangements. These waivers, however, will soon expire or have expired already. 

The following details should be considered before offering out-of-state remote employee work arrangements.

State income tax filing requirements

  • If your financial institution has an employee working remotely from a different state, the financial institution has created physical presence nexus in that state. Once nexus has been established, the financial institution may be subject to state and local income taxes, gross receipts taxes, unique taxes specific to financial institution, or franchise taxes. When it comes to taxing a financial institution, not all states assess tax in the same manner. 
  • After nexus has been established, your financial institution will also need to understand how the state apportions wages in determining income tax liability to the state. One example is a factor approach: Total payroll paid to employees working in the state divided by total payroll paid to all employees. In a simplified example, the fraction would be multiplied by taxable income resulting in amount of taxable income in that state. One employee in a state is not likely to create a significant income tax liability to the state, however, many states have minimum tax liabilities and other fees—some more significant than others—which should also be considered along with additional administrative costs. 

State tax withholding

  • Employees will need to pay personal state income tax based on their primary state of residence as well as the state in which they work. If your financial institution's remote employee is performing most of their work from home in a different state than the financial institution, and travels to the financial institution for occasional meetings or in-person days, this could result in the employee having a personal state income tax liability in both states. It may be necessary for your financial institution to track the employee’s location and properly withhold state income taxes from the employee’s pay based on the state that the employee is providing services. 
  • Failure to properly withhold state income taxes could create a liability for both the employee and the employer including penalties and interest. Proper policies should be in place regarding the responsibility of tracking where employees are performing their work may mitigate these concerns. You should encourage your employees to work with their individual tax advisors on state tax issues as each employee's tax filing position is unique (we generally advise against providing tax advice to your employees). 

Unemployment taxes and workers’ compensation

  • Unemployment is typically paid to the state in which an employee has their permanent place of work. Your financial institution should review the state’s unemployment rules to determine if the financial institution is required to collect and remit unemployment tax to a state that it has employees. If your employee is working in a different state on a temporary basis or due to the pandemic, we believe there is no need for unemployment to change from the state where the financial institution is located.
  • Workers’ compensation is also typically paid to the state in which the employee is permanently assigned. If the out-of-state work arrangement is temporary, we do not feel you need to change your workers’ compensation. However, if the out-of-state arrangement from home becomes permanent, you may need to change your policy. Some states require employers to have a minimum number of employees in the state before requiring a workers’ compensation policy in that state. We recommend working with BerryDunn’s employee benefits experts on state rules and discussing with your insurance carrier.

Personal property and other taxes

  • Employees working from home are often provided furniture and equipment for their remote office set up. Financial institutions should consider whether they want to provide these items without retaining ownership to the property, as owning property in another state could result in the financial institution needing to file and remit personal property taxes to the state. It also would be considered a best practice to develop a policy that provides consistency among all remote employees, regardless of their location. 
  • Sales and use tax implications and other special or unique state and local taxes should be researched and understood prior to entering any state to determine the impact on existing products and services which may be offered to out of state customers who reside or relocate out of state. We will provide more information about the state tax issues related to providing services in a future installment of this state tax series. 

Other considerations

  • We recommend you discuss with your financial institution's attorney regarding the need to file a business license or update the financial institution's charter as these are legal matters. Here are some topics to consider as you have these discussions:
    • Your financial institution may be required to register with the state department of revenue/taxation
    • Registering as a foreign corporation is often necessary to access the legal system
    • Your financial institution may want to consider whether other regulatory licenses may be needed, such as insurance broker or license for trust services
  • Health insurance and other employee benefit plans should be reviewed to ensure that a remote employee eligible to receive benefits still qualifies and receives the same level of coverage that is available to in-state employees. 

In summary, even one employee working out of state could create additional compliance costs and exposure to a state’s laws and regulations. You may be wondering how risky it is to have only one employee located in a state, and how likely is it that the state would make the connection to your out-of-state financial institution.

While  the risk may seem low, states are always looking to generate additional tax revenue, and many have the ability to cross check internal systems. Withholding and remitting state income taxes on behalf of an employee is likely going to require your financial institution to register with a state's income tax withholding agency. The state will then be aware of your financial institution’s connection to its state as the financial institution’s EIN will be in the system for payroll purposes. While the exposure may still be low, the state may start looking for an income tax filing and at least payment of minimum tax. Failure to file in a state means that the statute of limitations for the financial institution’s exposure to that state will not start.

The risks shouldn’t necessarily prevent your financial institution from allowing employees to work from home, and as many financial institutions want to offer more flexible work arrangements given what has been learned in recent years, it is possible to minimize tax risk and remain compliant with proper planning and awareness. 

For more information

To discuss your specific tax situation and state compliance risks, please contact the BerryDunn Financial Services team. We’re here to help.

Article
State tax issues impacting your financial institution part one: Remote employees

Release Date: July 07, 2022
Federal Register Publication Date: Scheduled for July 29, 2022
Effective Date: January 1, 2023
End of Comment Period: September 6, 2022

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment rates under the Physician Fee Schedule (PFS) for the calendar year 2023, as well as other Part B provisions. Following is a summary of the major provisions of this proposed rule.

PFS Proposed Changes to Conversion Factor:

  • PFS conversion factor reflects the statutory update of 0%, expiration of the 3% increase in PFS payments for CY2022 provided by the Consolidated Appropriations Act of 2021 (CCA), 1.55% reduction necessary for changes in relative value units for budget neutrality, and anesthesia-specific practice expense and malpractice adjustments of 0.53%.

Major Provisions Proposed:

  • Future rebasing and revision of the Medicare Economic Index (MEI) cost share weights that would use publicly available data from the US Census Bureau NAICS 6211 Offices of Physicians to set PFS payments rates. Using new MEI cost weights for PFS rate setting would not change overall spending on PFS services but would likely result in significant changes to payments among the various PFS services. Therefore, CMS is not proposing the use of the newly proposed method for CY2023 rate setting and is seeking comment on the proposed updated MEI cost share weights to calibrate payment rates and update the geographic practice cost indices (GPCI) under the PFS in the future.
  • Changes in coding and documentation for Other Visits (hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) intended to reduce administrative burden using a similar approach to changes finalized in the CY2021 PFS final rule for office/outpatient Evaluation and Management (E/M) visit coding and documentation. Also propose to maintain the current billing policies that apply to E/M visits while potential revisions are considered for future rulemaking. 
  • Delay the Split (or Shared) E/M visits policy finalized in CY 2022 related to the definition of substantive portion as more than half the total time. Until CY 2024, clinicians will continue to have a choice of meeting the definition of substantive portion based on history, physical exam, medical decision making, or more than half of the total practitioner time spent.
  • Proposing to cover several services that were temporarily available as telehealth services during the PHE through CY 2023 on a Category III basis and extending the time these services are temporarily included on the telehealth services list for a period of 151 days following the end the PHE. 
  • Telehealth claims would require the appropriate place of service (POS) indicator to be included on the claim instead of modifier “95” after the period of 151 days following the end of the PHE. For Medicare telehealth services furnished via audio-only technology modifier “93” would be available, where appropriate. 
  • Establish a new General Behavioral Health Integration (BHI) service for monthly care integration where mental health services performed by Clinical Psychologists (CP) or Clinical Social Workers (CSWs) is the focal point of care integration. This new General BHI service would also allow a psychiatric diagnostic evaluation to serve as the initiating visit. 
  • Make an exception to the direct supervision requirement under “incident to” regulations to allow behavioral health services provided by auxiliary personnel (such as licensed professional counselors and licensed marriage and family therapists) incident to the services of a physician or non-physician practitioner (NPP) to be allowed under general supervision of a physician or NPP, rather than under direct supervision.
  • Proposing new HCPCS codes and valuation for Chronic Pain Management and treatment services (CPM) that would include a bundle of services furnished during a month. 
  • Opioid Treatment Program (OTP) would revise the pricing methodology for the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone. CMS also proposes to allow the OTP intake to be furnished via two-way audio-video communications technology when billed for the initiation of treatment with buprenorphine, when authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and mental Health Services Administration (SAMHSA). Audio-only communication technology to initiate treatment with buprenorphine would also be permitted where audit-video technology is not available. 
  • Create a new G-code for audiologists to bill for services without a physician referral for non-acute hearing or balance assessments unrelated to disequilibrium, hearing aids or examinations for the purpose of prescribing, fitting, or changing hearing aids. Billing the new G-code would be limited to once every 12 months.
  • Expand coverage for certain colorectal cancer screening tests by reducing the minimum age to 45 years and considering a follow-up screening colonoscopy after a Medicare covered at-home test to be a preventative service.
  • Preventive vaccine administration would receive annually updated payment amount based on the increase in the MEI and adjustment for geographic locality. Also, CMS proposes to continue the additional payment for at-home COVID-19 vaccinations and clarifies that policies regarding the administration of COVID-19 vaccines and monoclonal antibody products will continue until the Emergency Use Authorization (EUA) declaration for drugs and biological products is terminated.
  • CMS proposes a variety of changes for the Quality payment Program and Medicare Shared Savings Program.

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs):

  • Add the new chronic pain management and behavioral health integration services to the RHC/FQHC-specific general care management HCPCS code, G0511.
  • Policies to extend telehealth flexibilities for 151 days after the PHE would be applicable to RHCs and FQHCs as well. 
  • Provider-based RHC’s payment limit per visit would be established by using a 12-consecutive month cost report. 

Sources: 
CMS-1770-P Medicare and Medicaid Programs; CY 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicare and Medicaid Provider Enrollment Policies, Including for Skilled Nursing Facilities; Conditions of Payment for Suppliers of Durable Medicaid Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); and Implementing Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs to Provide Refunds with Respect to Discarded Amounts

Article
Medicare Proposed Rule for CY 2023 Medicare Physician Fee Schedule

Release Date: July 15, 2022
Federal Register Publication Date: Scheduled for July 26, 2022
Effective Date: January 1, 2023
End of Comment Period: September 13, 2022

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment rates and policies for outpatient hospitals and Ambulatory Surgery Centers (ASC) for the calendar year 2023, as well as other provisions. Following is a summary of the major provisions of this proposed rule.

OPPS/ASC Proposed Changes to Payment Rates:

  • Net increase in FY 2023 Medicare OPPS/ASC rates of 2.7% for hospitals that meet relevant quality reporting requirements, broken down as follows:

  • Continue 2% reduction for hospitals that fail to meet quality reporting requirements

Rural Emergency Hospitals (REH) Payment Policies:

  • Covered outpatient department services would be paid OPPS plus 5%. Medicare beneficiary coinsurance will not be applied to the additional 5%.
  • Monthly facility payment is proposed to be $268,294 in CY 2023 and subsequently increased by the hospital market basket %.  The initial monthly facility payment calculation is based on the 2019 average payment difference between CAHs and amounts the CAHs would’ve been paid under PPS
  • Outpatient services not paid under OPPS (e.g., paid under Clinical Lab Fee Schedule) and provider-based Skilled Nursing Facilities (SNFs) would not be considered REH services (not receive enhanced payment)
  • Propose an expedited enrollment process for Critical Access Hospitals (CAH) converting to the new REH designation

Other Major Provisions Proposed:

  • Rate setting would be based on CY 2021 claims data and June 2020 Cost Report data from HCRIS, which only includes cost reports that predate the public health emergency
  • Removes 10 services from the Inpatient Only List (mostly maxillofacial procedures) and adds 1 service to the ASC Covered Procedures List (lymph node biopsy or excision)
  • Proposes paying 340(b) drugs at Average Sales Price (ASP) minus 22.5%. However, considering the June 15th Supreme Court’s decision that CMS may not vary payment rates for drugs without conducting an acquisition cost survey, CMS anticipates revising this provision during final rulemaking to ASP plus 6%, with the corresponding reduction in the conversion factor for budget neutrality.
  • Paying separately for certain non-opioid pain management drugs in the ASC setting to ensure there are no financial disincentives to using these alternatives to opioids. CMS is proposing separate payment for 4 non-opioid pain management drugs that function as surgical supplies, including certain local anesthetics, and ocular drugs, in the ASC setting. 
  • Covering behavioral health services furnished remotely to beneficiaries in their homes, including proposed requirements for in-person services within 6 months prior to the initial remote service and within 12 months following a remote service (some exceptions). Audio-only communications are also proposed to be covered in certain situations.
  • Proposes IPPS and OPPS payment adjustments for the additional cost of procuring domestically produced NIOSH-approved surgical N95 respirators. These payments would made bi-weekly as interim lump-sum payments and reconciled at cost report settlement, effective for cost reporting periods beginning on or after January 1, 2023. 
  • Proposes to exempt Rural Sole Community Hospitals (SCHs) from the clinic visit payment policy for excepted off-campus provider-based departments (PBD) under which the off-campus PBD is paid an amount equivalent to the Physician Fee Schedule. SCHs would be paid the full OPPS rate for excepted off-campus provider-based clinic visits. 
  • Partial Hospital Program (PHP) per diem rate structure would remain unchanged with a single Ambulatory Payment Classification (APC) for each provider type for days with 3 or more services per day
  • Adds prior authorization requirement for facet joint injections and nerve destruction in outpatient departments.
  • CMS proposes a variety of changes for the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs, as well as seeking comment on several measures. 

Sources: 
CMS-1772-P Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating
 

Article
Medicare Proposed Rule for CY 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System