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

Medicare Reimbursement

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...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes

by Jacqueline Belliveau

CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to 2,022 hospitals to end the appeals process...

OIG: NY Hospital Received $14.2M in Medicare Improper Payments

by Jacqueline Belliveau

A New York-based hospital overbilled Medicare by over $14.2 million between 2011 and 2012 because it did not have appropriate medical billing measures to prevent and identify improper payments, reported the Office of the Inspector General (OIG)....

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?

by Jacqueline Belliveau

Many long-term acute care facilities are projected to close over the next few years as Medicare enacts a payment reform rule that will introduce site-neutral payments for certain long-term acute care services, according to a Standard & Poor’s...

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts

by Jacqueline Belliveau

Over 120 general acute care hospitals have filed a lawsuit against Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell over Medicare reimbursement reductions under the two-midnight rule. The two-midnight rule stipulates...

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...

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...


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