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

Medicare Reimbursement

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...

End-of-Life Medicare Spending 25% Higher for Younger Seniors

by Jacqueline Belliveau

For most providers, it is not surprising that Medicare spending tends to increase in the last year of a beneficiary’s life, especially since this population is more likely to experience a serious illness and multiple chronic conditions....

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...

HHS Proposes Changes to Medicare Reimbursement Appeals Process

by Jacqueline Belliveau

Earlier this week, the Department of Health & Human Services (HHS) released a notice of proposed rulemaking (NPRM) to modify the Medicare reimbursement appeals process in efforts to reduce the substantial backlog of unresolved appeals. “The...

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 Targets Medicare Payment Reform for Home Health

by Jacqueline Belliveau

By 2017, home health agencies could see a 1.0 percent, or $180 million, reduction in reimbursements due to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that mandates Medicare payment reform. In a recent fact sheet,...

CMS: Proposed Changes to Dialysis, ESRD Claims Reimbursement

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) has recently announced proposed changes to claims reimbursement models for end-stage renal disease (ESRD) and dialysis as well as revisions to the competitive bidding program for durable medical...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline Belliveau

The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on competitive...

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

by Jacqueline Belliveau

The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues with...

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...

New DMEPOS Prices Reduce Medicare Spending, Ensure Care Access

by Jacqueline Belliveau

Riding on the success of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), CMS has announced that expanding competitive bidding prices for DMEPOS items nationwide has continued to reduce...

Rural Hospitals May Get Senate Help with Medicare Reimbursements

by Catherine Sampson

As the healthcare industry shifts from volume to value, hospitals are expected to provide quality care as many could also potentially face lower Medicare reimbursements. At the same time, many hospitals in rural and economically distressed areas...

How to Reduce Wasteful Spending in the Medicare Program

by Vera Gruessner

When the Affordable Care Act was passed several years ago, it had major implications for the future of the Medicare program. According to a study from the Private Enterprise Research Center at Texas A&M University, the Affordable Care Act...

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service payment...

CMS Proposes New Healthcare Payment Models for Medicare Part B

by Vera Gruessner

New healthcare payment models are being advised by the Centers for Medicare & Medicaid Services (CMS). From alternative payment models to the Medicare Shared Savings Program and the Comprehensive Care for Joint Replacement program, the federal...

Revenue Cycle Management Success is About the Fundamentals

by Jacqueline DiChiara

Revenue cycle management success is the heart of any healthcare organization. Defined as the clinical and administrative management of claims management, payment, and revenue production, revenue cycle management is in essence one large financial...

CMS Reports SNF Payment Incentives May Cut Medicare Spending

by Jacqueline DiChiara

Medicare spending is falling, according to an annual report from the Centers for Medicare & Medicaid Services (CMS) that assessed how to reduce avoidable hospitalizations for long-stay nursing facility residents. Well-targeted...

What Are the Greatest Revenue Cycle Management Challenges?

by Jacqueline DiChiara

RevCycleIntelligence.com recently polled over 60 readers to assess revenue cycle management challenges and opportunities, from the front-end, to the back-end, and everything in between. Readers said collecting payment from a patient in a timely...

55 Hospitals File Two-Midnight Rule Lawsuit Against HHS

by Jacqueline DiChiara

The healthcare industry is burning the two-midnight oil. Fifty-five hospitals filed a lawsuit last Friday against the Department of Health and Human Services (HHS) regarding the two-midnight rule’s 0.2 percent inpatient compensation...

HHS, CMS Speak Out on CMS’s Innovation Center Pilot Project

by Jacqueline DiChiara

Medicare reimbursements are preparing to emerge from a fee-for-service caterpillar’s cocoon to a value-based butterfly. The newly announced Accountable Health Communities [AHC] model – a CMS Innovation Center Pilot...

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