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

CMS

CMS Paid $35.2M in Non-compliant Claims

by Stephanie Reardon

Medicare paid approximately $35.2 million in 2010 in non-compliant claims for PMD. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on the Centers for Medicare & Medicaid...

CMS Audit Finds $17.6M Overstated for Excess Plan

by Stephanie Reardon

CMS audit discovers BCBS South Carolina overstated its allocable Excess Plan costs by approximately $17.6 million. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on Blue Cross...

New York State Agency Made $79K in Inappropriate Medicaid Claims

by Stephanie Reardon

State agency claimed Medicaid reimbursement for some home and community-based services provided by New York City providers that did not comply with Federal and State requirements. The Department of Health and Human Service (HHS) Office of Inspector...

CMS Administrator Marilyn Tavenner Steps Down

by Ryan Mcaskill

In an email to staff, Tavenner announced that February 2015 will be her last month as head of CMS. There is a major shakeup happening at the Centers for Medicare and Medicaid Services (CMS) as it has been revealed that CMS administrator Marilyn...

How can CMS Reform the Medicare Hospice Payment System?

by Stephanie Reardon

CMS must update the Medicare hospice payment system using the data gathered by this audit in order to meet the ACA requirements. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit...

CMS Restricts Ambulance Services for Improper Medicare Billing

by Stephanie Reardon

New Medicare billing regulation could limit the number of allowable ambulance transports and could reduce the revenue intake for ambulance services. Ambulance companies in New Jersey are in a bind. Past reports for improper Medicare billing for...

Preventable Readmissions Cost CMS $17 Billion

by Stephanie Reardon

The estimated annual cost of this problem for Medicare is $26 billion annually and $17 billion is considered avoidable. Preventable hospital readmissions are a big part of unnecessary medical spending. According to data from the Center for Health...

CMS Provides Clarity on $840M Quality Care and Cost Initiative

by Stephanie Reardon

CMS clarified the enrollment process for a quality care and cost initiative, and answer questions before the application process ends on February 5, 2015. In October, 2014 the Department of Health and Human Services (HHS) introduced a new initiative...

CMS Changes Medicare and Medicaid Audit Process

by Stephanie Reardon

CMS paid nearly $4 billion in improper Medicare payments. The Centers for Medicare & Medicaid Services (CMS) announced that it has expanded its contracts to four different companies – HealthDataInsights, CGI Federal, Connolly and Performant...

CMS Contractor to Refund $6.9M in Medicare Outlier Payments

by Stephanie Reardon

Noridian did not submit 10 Medicare cost reports to CMS for reconciliation and had not resolved the outlier payments from five of them. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of...

ICD-10 Acknowledgement Test Shows 87 Percent Acceptance Rate

by Ryan Mcaskill

The latest CMS ICD-10 acknowledgement test of 13,700 claims found an 87 percent acceptance rate of ICD-10 codes. It may seem as though the switch to ICD-10 is in a constant state of delay. While the current deadline to implement the inpatient...

Medicare Payments Reduced for Hospital-Acquired Conditions

by Stephanie Reardon

721 hospitals will face a one-percent reduction in Medicare payments from the federal government. Despite incentives for hospitals to reduce hospital-acquired conditions (HACs), 721 hospitals will face a one-percent reduction in Medicare payments...

CMS Paid $22 Million in Inappropriate Medicare Claims

by Stephanie Reardon

Medicare paid $22 million for ophthalmology medicare claims in 2012 that were potentially inappropriate. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its auditon the Centers for Medicare...

CMS Adds Confusion to CME Open Payment Requirements

by Ryan Mcaskill

An update to the Open Payment database clouds requirements for reporting data to continuing medical education activities. The Sunshine Act and Open Payment database continues to be a controversial entity. Since it was launched in September, a...

Medical Billing Data Made Public to Improve Transparency

by Stephanie Reardon

New information could be useful for improving care. Transparency within the healthcare market may be easier to achieve following the release of the Physician Data File. The Commonwealth Fund has conducted an analysis of the Obama administration’s...

CMS Rule Limits Payments to Disproportionate Share Hospitals

by Stephanie Reardon

CMS final rule defines ‘uninsured,’ allowing Medicaid patients with exhausted applicable state coverage limits to be covered. Effective December 31, disproportionate share hospitals (DSH) will be subject to the Centers for Medicare...

CMS Strengthens Medicare Provider Safeguards with New Rule

by Ryan Mcaskill

A new final CMS rule will be make participation in Medicare incentive programs more difficult for bad actors. Earlier this week, RevCycleIntelligence.com covered a report from the Government Accountability Office that examined Medicare drug...

CMS Proposes Rule Changes for Accountable Care Organizations

by Ryan Mcaskill

Several potential new rules would strengthen the Medicare Shared Savings Program by altering risk/reward, enrollment and more. Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced several proposed changes that will strengthen...

CMS Addressing Medicare Drug Fraud, Waste, Abuse

by Stephanie Reardon

The Government Accountability Office compiled a report to determine practices to promote prescription drug program integrity. Because of recent law enforcement actions and the increase in focus in the media highlighting Medicare prescription...

CMS Creates Office of Enterprise Data and Analytics

by Ryan Mcaskill

Niall Brennan is CMS’ first chief data officer to improve the agency’s analytics to improve quality care at a lower cost. Big data has become more than just a buzzword across the business landscape. It is a major strategy that organizations...

Continue to site...