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

Medicare Reimbursement

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

March 21, 2017 - In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since 2009. MedPAC previously submitted healthcare payment reform suggestions for post-acute care, such as skipping annual payment updates, lowering Medicare reimbursement...


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MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline Belliveau

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since 2009....

274 Orgs Calls on CMS to Add Medicare Advantage Advanced APMs

by Jacqueline Belliveau

CMS should develop financial incentives comparable to those in the Quality Payment Program’s Advanced Alternative Payment Model (APM) track for providers who assume financial risk under Medicare Advantage plans, CAPG and 273 other healthcare...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

by Jacqueline Belliveau

The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS stated...

CMS Awards $100M for Small, Rural Clinician MACRA Help

by Jacqueline Belliveau

ORLANDO - CMS recently selected 11 healthcare organizations to receive a total of $100 million in funding to help small and rural eligible clinicians participate in the newly-launched MACRA. Each organization received $20 million to provide hands-on...

One-Third of Healthcare Execs Ready for MACRA Implementation

by Jacqueline Belliveau

Only 35 percent of healthcare executives said that their organization has a MACRA implementation strategy and feels prepared for the new value-based reimbursement program, according to a recent Health Catalyst and peer60 survey. The survey of...

AMGA: Slow Encounter Data Transition in Medicare Reimbursement

by Jacqueline Belliveau

The American Medical Group Association (AMGA) recently commended CMS for decelerating the transition to using encounter data as a means for risk-adjusting Medicare reimbursement to Medicare Advantage organizations in 2018. In an announcement...

Patient Care Navigation Program Reduces Cancer Care Costs

by Jacqueline Belliveau

Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study revealed. From...

AAFP: Primary Care Undervalued in Medicare Reimbursement

by Jacqueline Belliveau

CMS released updated physician fee schedule rates in November 2016, but the American Academy of Family Physicians (AAFP) recently contended that Medicare reimbursement rates for primary care providers are still lacking. In a letter to CMS, the...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a comment...

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

by Jacqueline Belliveau

A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative law judge level. HHS projected the backlog...

How the 21st Century Cures Act Impacts Medicare Reimbursement

by Jacqueline Belliveau

The 21st Century Cures Act may have been a landmark law for precision medicine, drug innovation, telemedicine, and mental health reform, but the law also contained several Medicare reimbursement policy changes set to take effect starting this...

CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

by Jacqueline Belliveau

With the site-neutral Medicare reimbursement policy taking effect on Jan. 1, CMS recently released guidance on what hospital departments qualify for exemption from the rule. The federal agency clarified expanded site-neutral payment exemption...

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....

OIG Finds Medicare Payment Problems with Two-Midnight Policy

by Jacqueline Belliveau

Hospitals may face more Medicare reimbursement audits on inpatient and outpatient claims after the Office of the Inspector General (OIG) recently found several vulnerabilities associated with the Two-Midnight policy. Using hospital and provider...

How Social Risk Factors Influence Value-Based Reimbursement

by Jacqueline Belliveau

Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and rural...

AHA Asks CMS to Increase Site-Neutral Medicare Reimbursement

by Jacqueline Belliveau

The American Hospital Association (AHA) recently advised CMS to increase Medicare reimbursement rates to off-campus provider-based outpatient departments that will be paid under site-neutral payment rules starting on Jan. 1, 2017. The industry...

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

by Jacqueline Belliveau

Medicaid and Medicare reimbursement in 2015 was under actual hospital costs for treating beneficiaries by $57.8 billion, the American Hospital Association (AHA) recently reported. According to data from the AHA’s Annual Survey of US Hospitals,...

Judge Calls for Medicare Appeals Backlog Elimination by 2020

by Jacqueline Belliveau

The Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog at the administrative law judge review level by Dec. 31, 2020, a federal judge recently decided. The most recent decision ends a two-and-a-half-year...

AHA, FAH: ACA Repeal Could Cost Hospital Revenue Cycle Billions

by Jacqueline Belliveau

Providers could face billions in hospital revenue cycle losses if the Affordable Care Act is repealed without replacement legislation that preserves health coverage increases and rolls back claims reimbursement cuts, stated the American Hospital...

NY Senator Challenges Rural Medicare Reimbursement Repayment

by Jacqueline Belliveau

New York Senator Charles Schumer (D-NY) recently spoke out against a CMS plan to recoup supplemental Medicare reimbursement to rural hospitals that could cause hospitals in New York alone to repay the federal agency $15 to $20 million for payments...

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