Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

CMS

Net Medicare Improper Payment Recoveries Dropped 91% in 2015

December 29, 2016 - Medicare improper payment recoveries saw a significant drop in 2015, according to a recent CMS report to Congress. The Recovery Audit Contractor (RAC) program returned 91 percent less to Medicare during the 2015 fiscal year compared to 2014. In 2015, RACs recouped a net of $141.87 million after accounting for program operating expenses, Medicare underpayments reimbursed to providers, appeals...


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Net Medicare Improper Payment Recoveries Dropped 91% in 2015

by Jacqueline Belliveau

Medicare improper payment recoveries saw a significant drop in 2015, according to a recent CMS report to Congress. The Recovery Audit Contractor (RAC) program returned 91 percent less to Medicare during the 2015 fiscal year compared to 2014....

CMS Unveils New Medicare APMs for Quality Payment Program

by Jacqueline Belliveau

CMS finalized several new Medicare alternative payment models that will qualify for a five percent value-based incentive payment through the Quality Payment Program. The announcement contained bundled payment initiatives for cardiac and orthopedic...

PQRS Medicare Payment Adjustments Waived After ICD-10 Update

by Jacqueline Belliveau

Some eligible professionals and group practices will not receive Physician Quality Reporting System (PQRS) Medicare payment adjustments in 2017 and 2018 because of the recent ICD-10 update, CMS recently announced in an email. The announcement...

2018 Advanced APM Options Added to Quality Payment Program

by Jacqueline Belliveau

Eligible clinicians now have more opportunities to earn value-based incentive payments by participating in the Advanced Alternative Payment Model track of the Quality Payment Program in 2018, according to a recent CMS announcement. Starting in...

CMS Hinders Private Plan Steering for Claims Reimbursement Bump

by Jacqueline Belliveau

CMS recently released an interim final rule designed to prevent providers at Medicare-certified dialysis centers from inappropriately steering patients away from Medicare and Medicaid in order to get higher claims reimbursement rates under the...

CMS Proposes to Limit Supplemental Medicaid Reimbursement

by Jacqueline Belliveau

CMS recently proposed a rule that would limit a state’s ability to create or increase a Medicaid reimbursement structure for hospitals, physicians, and nursing homes that pays providers for services that are not related to care delivery...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

by Jacqueline Belliveau

In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims accounted for $10.45 billion in improper payments...

CMS Updates Site-Neutral Payment Reform Implementation Rule

by Jacqueline Belliveau

In a recent ruling on the outpatient prospective payment system, CMS finalized several changes to the site-neutral payment reform policy under which most provider-based hospital outpatient departments will no longer receive outpatient Medicare...

CMS Issues Final Rule on Home Health Medicare Reimbursement

by Jacqueline Belliveau

CMS recently released a final rule that will reduce Medicare reimbursement to home health providers by $130 million, or 0.7 percent, in 2017. Lower Medicare spending on home health services will stem from updates to payment rates, the Home Health...

CMS Updates ESRD, Dialysis Medicare Reimbursement Policies

by Jacqueline Belliveau

End-stage renal disease (ESRD) and dialysis providers can expect a 0.73 percent increase in total payments compared to last year under new Medicare reimbursement rates, CMS recently announced. Medicare spending on ESRD payments is projected to...

CMS Launches VT All-Payer Accountable Care Organization Model

by Jacqueline Belliveau

Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

CMS Announces New Advanced Alternative Payment Model Options

by Jacqueline Belliveau

CMS recently announced new opportunities for eligible clinicians to participate in an Advanced Alternative Payment Model (APM) under the Quality Payment Program in 2017 and 2018. The Oncology Care Model’s two-sided financial risk track...

CMS: Rural Healthcare Faces Hospital Revenue Cycle Challenges

by Jacqueline Belliveau

In a statement at the CMS Rural Health Summit yesterday, CMS Acting Administrator Andy Slavitt identified rural communities as one of the biggest opportunities for healthcare reform because rural areas face more hospital revenue cycle challenges,...

CMS Launches Provider Engagement, Value-Based Care Initiative

by Jacqueline Belliveau

CMS recently announced a new provider engagement initiative designed to improve the clinician experience within the Medicare program, especially as value-based care models are developed under the Affordable Care Act and MACRA. As alternative...

GOP Doctors Caucus Suggests MACRA Implementation Changes

by Jacqueline Belliveau

In a recent letter to CMS Acting Administrator Andy Slavitt and Director of the Office of Management and Budget Shaun Donovan, the GOP Congressional Doctors Caucus called for several MACRA implementation changes to make the value-based reimbursement...

GAO: Healthcare Spending Data from CMS Inaccessible, Unreliable

by Jacqueline Belliveau

CMS should make healthcare spending data for skilled nursing facilities more accessible to public stakeholders and ensure the expenditure information is reliable, the Government Accountability Office (GAO) advised the federal agency in a recent...

House Reps Urge CMMI to Cease Mandatory Payment Reform Models

by Jacqueline Belliveau

In a recent letter to CMS leaders, House representatives urged the federal agency to stop all mandatory payment reform demonstrations through the Center for Medicare and Medicaid Innovation (CMMI), such as the ongoing Comprehensive Care for Joint...

CMS Selects 2 Orgs to Provide MACRA Implementation Support

by Jacqueline Belliveau

CMS will award up to $5 million to the Virginia Cardiac Service Quality Initiative and the American Psychological Association  to provide primary and specialist care providers with MACRA implementation support.  The two organizations...

Preventable Readmissions Drop Under Value-Based Care Model

by Jacqueline Belliveau

Forty-nine states and Washington DC have decreased preventable hospital readmissions under a Medicare value-based care initiative that financially penalizes hospitals with excess readmissions, reported CMS. “The Hospital Readmissions Reduction...

CMS Releases DMEPOS Medicare Reimbursement Rates, Contracts

by Jacqueline Belliveau

CMS has announced new Medicare reimbursement rates for some medical equipment items and started to send contract offers to winning bidders for Medicare’s Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)...

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