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

Medicare Reimbursement

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...

Bundled Payments Model Cuts Joint Replacement Costs by $1,166

by Jacqueline Belliveau

Hospitals participating in the Bundled Payments for Care Improvement initiative decreased Medicare spending on lower extremity joint replacement hospitalizations by $1,166 per episode compared to non-participating hospitals, reported a study...

Group Calls for Dual-Eligible Claims Reimbursement Changes

by Jacqueline Belliveau

In a recent report, the Bipartisan Policy Center’s Health Project has urged federal officials to improve care delivery for dually eligible Medicaid and Medicare beneficiaries by revising claims reimbursement models to better align with...

Court Denies HHS Wish to Delay Medicare Appeals Backlog Case

by Jacqueline Belliveau

A federal district court recently denied a request from the Department of Health and Human Services (HHS) to postpone proceedings on a Medicare appeals backlog case until Sept. 30, 2017, according to the court’s decision. US District Judge...

Post-Acute Care Groups Oppose Value-Based Purchasing Program

by Jacqueline Belliveau

Eight healthcare industry groups recently told lawmakers that they oppose the proposed Medicare Post-Acute Care Value-Based Purchasing Program, which is scheduled to start on Oct. 1, 2019. In a letter to the House Committee on Ways and Means,...

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)...

AMGA: Tie Medicare Reimbursement to Care Coordination Metrics

by Jacqueline Belliveau

According to two comment letters to CMS, the American Medical Group Association (AMGA) has urged the federal agency to better align Medicare reimbursements and value-based incentive payments to promote enhanced care coordination. The industry...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

by Jacqueline Belliveau

Medicare spending would decrease by approximately $19 million a year once CMS fully implements new claims reimbursement rates for accessories associated with some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), reported...

Industry Groups Call on CMS to Modify MACRA Patient Codes

by Jacqueline Belliveau

Proposed patient relationship codes that will be used under MACRA to measure appropriate resource use and determine value-based reimbursement adjustments may cause more confusion for providers and increase administrative burdens, according to...

MedPac Suggests More Claims Reimbursement Cuts for Home Health

by Jacqueline Belliveau

The Medicare Payment Advisory Commission (MedPac) is advising CMS to deepen proposed Medicare reimbursement cuts to home health advisors to better align with actual costs and compensate for systematic overpayments. The call for more reductions...

Can Changes to Medicare Reimbursement Appeals Reduce Backlog?

by Jacqueline Belliveau

The lengthy Medicare reimbursement appeals process poses significant revenue cycle management problems for many providers, yet new proposed fixes from HHS may not do much to solve the problem, argue several industry groups. In June, HHS proposed...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

by Jacqueline Belliveau

The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to recent...

AHA: Delay Site-Neutral Rule to Address Medicare Fraud Risks

by Jacqueline Belliveau

The American Hospital Association (AHA) has asked CMS to delay the implementation of proposed site-neutral payments for another year because the payment reform rule could increase a hospital’s Medicare fraud and abuse risks. Site-neutral...

AHA Critiques Medicare Reimbursement Changes for Home Health

by Jacqueline Belliveau

The American Hospital Association (AHA) is urging CMS to delay outlier provisions and streamline certain medical billing procedures proposed in a recent document aimed at home health facilities. In June, CMS released a proposed rule that would...

CMS Must Inform Providers on New Medicare Reimbursement Policy

by Jacqueline Belliveau

A Vermont judge has ordered CMS to further educate providers and auditors about a recent Medicare reimbursement policy that affects skilled nursing and rehabilitation facilities, reported the Center for Medicare Advocacy. The court stated that...


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