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


CMS Issues Final Changes for Medicare Reimbursement Programs

by Jacqueline Belliveau

CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website. Healthcare providers in the Medicare...

CMS Updates Part A Claims Reimbursement, Auditing Policies

by Jacqueline Belliveau

To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will be limited to a six-month look-back period...

New Rules for Bundled Payment Models for Cardiac, Hip Care

by Jacqueline Belliveau

CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25, 2016, the...

CMS Saves $42B Through Healthcare Fraud Prevention Activities

by Jacqueline Belliveau

By using a more proactive approach to healthcare fraud protection, CMS has saved the Medicaid and Medicare programs nearly $42 billion in fiscal years 2013 and 2014. In a post on its official blog, CMS attributed the savings to an increase in...

CMS Proposes Medicare Payment Reform Rule for Primary Care

by Jacqueline Belliveau

In efforts to better support primary care physicians, CMS has announced a proposed Medicare payment reform rule that would improve payment accuracy for providers who treat chronically ill and medically complex patients. The rule would update...

CMS Proposes to Update Medicare Reimbursement Rates for OPPS

by Jacqueline Belliveau

According to a press release, CMS has proposed changes to Medicare reimbursement rates and policies in the Hospital Outpatient and Ambulatory Surgical Centers prospective payment systems. The agency stated that the proposals account for stakeholder...

House Reps Ask for FFS Waivers for Alternative Payment Models

by Jacqueline Belliveau

CMS should make it easier for fee-for-service providers to get involved in risk-based alternative payment models by reducing regulatory barriers, House representatives said in a letter this week. The seventy representatives asked CMS to waive...

CMS Selects 200 Groups for Value-Based Care Oncology Model

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) has announced that almost 200 physician groups and 17 health insurance companies will join the Oncology Care Model, a value-based care program starting in July for providers who furnish chemotherapy...

CMS Proposes Revisions to Medicaid Improper Payment Programs

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) is calling on healthcare stakeholders to comment on a proposed rule that would change how states identify improper payments stemming from Medicaid and Children’s Health Insurance Program...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

by Jacqueline Belliveau

A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week, Medicare reimbursement...

OIG: Provider-Based Status Leads to Improper Medical Billing

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) could reduce improper medical billing by eliminating provider-based designations or equalizing payments for the same services provided at different care sites, according to a recent report...

CMS Announces Pre-Claims Reimbursement Review for Home Health

by Jacqueline Belliveau

In efforts to combat Medicare fraud and provide more timely care to beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has issued a rule that requires some home health agencies to undergo a pre-claim review to qualify for full...

60% of RAC Reviewed Claims Showed No Medicare Overpayments

by Jacqueline Belliveau

Reducing healthcare fraud, waste, and abuse has recently been on the top of the CMS agenda, but some healthcare providers are questioning how effective some CMS initiatives are at identifying potential Medicare overpayments. The American Hospital...

OIG: CMS Lacked Good Management Policies for Pioneer ACO Model

by Jacqueline Belliveau

The Pioneer Accountable Care Organization (ACO) program faced a number of management and leadership challenges during its early days, according to a report from the Office of the Inspector General (OIG).  The report indicates CMS faced several...

Medicare Shared Savings Program Gets New Cost Calculations

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) has recently finalized a rule that will change the methodology for calculating costs under Medicare Shared Saving Program, the federal agency announced. MSSP accountable care organizations...

CMS Allows Some ACOs to Join New Value-Based Care Model

by Jacqueline Belliveau

CMS has expanded the eligibility requirements in the Comprehensive Primary Care Plus (CPC+) model to include primary care physicians in certain Medicare accountable care organizations (ACOs), according to an updated fact sheet. Up to 1,500 primary...

Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud

by Jacqueline Belliveau

Using big data tools and predictive analytics, the Centers for Medicare and Medicaid Services (CMS) has saved approximately $1.5 billion by preventing Medicare fraud in the traditional fee-for-service program, according to the official CMS blog....

Congress Asks CMS to Scrap Prior Authorization for Home Health

by Catherine Sampson

A CMS proposal to require a prior authorization screening for every home health service would be an administrative nightmare and may produce barriers to care for needy patients, a group of 116 lawmakers said in a letter to CMS this week. "This...

GAO: Weak Medicare, Medicaid Provider Screening Allows Fraud

by Catherine Sampson

The Centers for Medicare & Medicaid Services’ (CMS) provider enrollment screening process is vulnerable to fraud because many ineligible providers are still being entered into the Provider Enrollment, Chain and Ownership System (PECOS),...

Newly Launched MACRA Initiative Aims to Support Providers

by Catherine Sampson

On May 25, American Medical Group Association (AMGA) launched a resource to help its members prepare for MACRA implementation as well as all risk-based payment systems. “We are making it our priority to ensure our members have the tools...


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