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

Medicare Reimbursement

AHA Urges Congress to Pass Healthcare Payment Reform Bills

by Jacqueline Belliveau

The American Hospital Association (AHA) recently called on Congress to pass several healthcare payment reform bills, such as the Helping Hospitals Improve Patient Care Act and the Sustaining Healthcare Integrity and Fair Treatment Act of 2016,...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

by Jacqueline Belliveau

The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention inefficiencies....

Using an Alternative Payment Model to Reduce Hospitalizations

by Jacqueline Belliveau

Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the University...

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...

Potential Challenges, Benefits of the Cardiac Bundled Payment

by Jacqueline Belliveau

Earlier this year, CMS proposed a cardiac bundled payment model that would reduce Medicare spending by $170 million on five years, but a new report in the Journal of the American Medical Association identified several potential drawbacks of the...

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 Offers 66% Settlement to Reduce Medicare Appeals Backlog

by Jacqueline Belliveau

In an effort to resolve the Medicare appeals backlog, CMS recently reopened a settlement option that would allow hospitals to receive partial reimbursement for some claim denials currently stuck in the appeals process. Similar to the 2014 settlement...

Large Hospitals Fare Worse in Value-Based Reimbursement Model

by Jacqueline Belliveau

Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive Healthcare,...

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...

Senate Group Drafts Chronic Disease Management Payment Reform

by Jacqueline Belliveau

The Senate Finance Committee Chronic Care Working Group recently released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, telehealth consultations, accountable...

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...

Patients Find Medicare Reimbursement to Surgeons Too Low

by Jacqueline Belliveau

Patients may be willing to pay more out-of-pocket expenses for certain medicals services, such as knee surgeries, especially as providers face lower Medicare reimbursement rates, a recent study in Orthopedics contended. The survey of 231 patients...

AHA Offers HHS Solutions to Reduce Medicare Appeals Backlog

by Jacqueline Belliveau

The American Hospital Association (AHA) recently advised the Department of Health and Human Services (HHS) to implement three solutions that would significantly reduce the Medicare appeals backlog at the administrative law judge level. The potential...

Medicare Reimbursement Covers 88% of Medical Equipment Costs

by Jacqueline Belliveau

Medicare reimbursement rates under the Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program only cover 88 percent of overall healthcare costs associated with providing home medical equipment, according...

Hospitals Still Facing Medicare Claims Denial Management Issues

by Jacqueline Belliveau

A recent American Hospital Association (AHA) survey indicated that hospitals are still experiencing challenges with Medicare claims denial management under the Recovery Audit Program. The survey of 676 hospitals revealed that about 60 percent...

Impact of Quality Payment Program on Medicare Reimbursement

by Jacqueline Belliveau

With the final rule on MACRA implementation finally emerging, eligible clinicians were presented with a range of Quality Payment Program participation options that would impact Medicare reimbursement payment adjustments in 2019. The Quality Payment...

Higher Medicare Reimbursement Not Related to Better Quality

by Jacqueline Belliveau

According to a recent study in JAMA Surgery, Medicare reimbursement amounts for patients who were rescued from surgical complications were two to three times greater at the highest cost-of-rescue hospitals, even though patient outcomes were similar...

OIG: Add Medical Device Data to Claims Reimbursement Forms

by Jacqueline Belliveau

Claims reimbursement forms lacking appropriate fields for medical device information make it more difficult for CMS to reduce Medicare spending associated with recalled or failed devices, the Department of Health and Human Services (HHS) Inspector...

AMGA Voices Concerns Over Cardiac Care Bundled Payments Model

by Jacqueline Belliveau

With the comment period on a proposed cardiac care bundled payments model closing earlier this week, the American Medical Group Association (AMGA) penned a letter to CMS Acting Administrator Andy Slavitt critiquing the mandatory Medicare demonstration....

Are Medicare Value-Based Penalties Fair to Safety Net Hospitals?

by Jacqueline Belliveau

Safety-net hospitals have to work harder to avoid value-based penalties than other participants in a Medicare program designed to reduce hospital readmissions, a new study in Health Affairs indicates. While safety-net hospitals have made significant...

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