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

CMS

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)...

Four New MACRA Tracks Allow Flexible Attestation for Providers

by Jacqueline Belliveau

Eligible clinicians will be able to select their own pace for MACRA attestation to ensure all participants can succeed under new value-based reimbursement programs, CMS announced. On its official blog, the head of CMS detailed four options for...

House Reps Ask CMS for MACRA Implementation Flexibilities

by Jacqueline Belliveau

Representatives from the House Ways and Means Committee and the House Energy and Commerce Committee have penned a letter to HHS Secretary Sylvia Mathews Burwell calling for more flexibilities with MACRA implementation. With the value-based care...

CMS Touts Progress of State-Led Alternative Payment Model

by Jacqueline Belliveau

States participating in the first phase of the State Innovation Model Initiative have made significant progress in implementing alternative payment models, CMS officials revealed midweek. Two of six states were able to link more than half of...

CMS: Medicare Accountable Care Organizations Saved Over $466M

by Jacqueline Belliveau

Medicare accountable care organizations (ACOs) saved more than $466 million in 2015, with 125 ACOs qualifying for shared savings payments under the value-based care model, CMS reported in an announcement earlier this week. “The coordinated,...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes

by Jacqueline Belliveau

CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to 2,022 hospitals to end the appeals process...

CMS Prepares Providers for End of ICD-10 Coding Flexibilities

by Jacqueline Belliveau

Starting on October 1, CMS plans to thaw the freeze on ICD-10 implementation by adding more codes and allowing review contractors to deny claims based on level of specificity. To help healthcare providers prepare for updates to ICD-10 coding...

$17B Increase in Medicare Part D Prescription Drug Spending

by Jacqueline Belliveau

Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription drug spending...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan

by Jacqueline Belliveau

CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal agency. The...

At-Home Service Value-Based Care Model Saves Medicare $10M

by Jacqueline Belliveau

A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending. Medicare saved $10 million during the...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement

by Jacqueline Belliveau

States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid pass-through...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States

by Jacqueline Belliveau

To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its website. “CMS is continuing its efforts...

CMS Final Rule Updates Inpatient Claims Reimbursement System

by Jacqueline Belliveau

Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the Medicare Hospital...

CMS Opens Enrollment for Value-Based Primary Care Model

by Jacqueline Belliveau

CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September 15,...

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