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

Policy & Regulation News

NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

April 24, 2017 - The National Association of ACOs (NAACOS) recently urged CMS to indefinitely suspend upcoming mandatory Medicare bundled payment models until the federal agency resolves financial conflicts between the episodic arrangements and accountable care organizations (ACOs). “The overlap of ACOs with bundled payment initiatives such as the mandatory bundles created in the EPM [Episode Payment...


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2 APMs Take Next Step As MACRA Physician-Focused Payment Models

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Two proposed physician-focused payment models will go to the HHS Secretary for possible limited-scale testing, while one model was stopped from becoming a potential alternative payment model under MACRA, the Physician-Focused Payment Model Technical...

CMS Calls On Rural Hospitals to Join Alternative Payment Model

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CMS is seeking applicants to participate in a new round of the Rural Community Hospital Demonstration Program that tests a cost-based alternative payment model among small rural hospitals. Lawmakers authorized a five-year extension of the demonstration...

Senators Push Bill to Address Physician Shortage in Rural Areas

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Three senators recently introduced a rural healthcare bill that would extend the Conrad State 30 Program until 2021 to help alleviate the physician shortage in designated Health Professions Shortage Areas or Medically Underserved Areas. Senators...

Keep Medicare Bundled Payment Models Mandatory, Experts Say

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Switching Medicare bundled payment models that are currently mandatory in select regions to voluntary across the country would impede value-based reimbursement progress through episodic payment, industry experts warned the Trump administration...

AHA: Uncompensated Care Costs Worksheet Inaccurate, Inconsistent

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The American Hospital Association (AHA) recently called on CMS to audit and modify the hospital cost report, Worksheet S-10, before the federal agency uses the report to determine each hospital’s uncompensated care costs and supplemental...

Medicaid Expansion Linked to $5M Annual Hospital Revenue Boost

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Hospital revenue in Medicaid expansion states increased by $5 million annually per facility after states chose to extend Medicaid coverage to more individuals, a recent Robert Wood Johnson Foundation and Urban Institute report showed. The study...

Healthcare Mergers May Face New Federal Rules Under SMARTER Act

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In a 16 to 20 vote earlier this week, the House Judiciary Committee passed the Standard Merger and Acquisition Reviews Through Equal Rules Act (SMARTER Act), which could affect how federal antitrust agencies evaluate healthcare mergers and acquisitions....

AMGA Supports 15% Limit for Medicare Advantage Encounter Data

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AMGA recently applauded CMS for further reducing the percentage of encounter data to be used to determine Medicare Advantage enrollee risk scores from 25 percent in the proposed rule to 15 percent in the final 2018 performance year update. “It...

AMGA President, CEO Donald W. Fisher, PhD, Passes at 71

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AMGA President and CEO, Donald W. Fisher, PhD, CAE, passed earlier this week after battling cancer, the healthcare industry group reported. Fisher, who was 71 years old, had led the organization since 1980. “Don leaves a professional and...

CMS Delays Rollout of Cardiac, Ortho Bundled Payment Programs

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CMS is pushing back the start date for a number of its bundled payment programs in an effort to provide additional time to review and prepare for the initiatives. In a notice posted in the Federal Register, CMS has issued three-month delays for...

Senate Confirms Seema Verma as Next CMS Administrator

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In a 55 to 43 vote yesterday, the Senate confirmed Seema Verma as the next CMS Administrator, according to a New York Times article. Verma, the founder, president, and CEO of a health policy consulting firm, will be charged with managing...

AHA, FAH Oppose Proposed Physician Self-Referral Law Changes

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The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) recently urged lawmakers to oppose a proposed bill that would extend physician self-referral allowances to physician-owned hospitals. In late February, House...

MGMA to Price: Simplify MACRA, Reassess Alternative Payment Models

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MGMA would like HHS Secretary Tom Price to reduce the regulatory burdens of HIPAA and MACRA, reassess the development of Alternative Payment Models (APMs), and postpone implementation of the ONC’s 2015 Certified EHR criteria, the organization...

52-47 Senate Vote Confirms Tom Price as New HHS Secretary

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Early this morning, the Senate approved Tom Price as the new Department of Health and Human Services (HHS) Secretary by a 52 to 47 vote, according to multiple sources. Price, a Republican representative from Georgia, will be the first provider...

HHS: Physician Self-Referral Law Hinders Value-Based Care

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Some healthcare fraud prevention regulations many impede value-based care models that use financial incentives to encourage providers to improve care quality and reduce healthcare costs, the Department of Health and Human Services (HHS) recently...

AMA: Eliminate Prior Authorization for Opioid Abuse Treatment

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The American Medical Association (AMA) recently called on attorney generals across the nation to follow in New York’s footsteps with reforming prior authorization requirements for medication-assisted treatment for opioid abuse. New York’s...

Healthcare Execs Ponder Financial Impact of Possible ACA Repeal

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With a possible full or partial Affordable Care Act repeal in the near future, healthcare executives called for some of the healthcare reform law’s provisions to continue, such as increased insurance coverage and the value-based reimbursement...

Hospitals, Health Systems Eye Financial Snags in ACA Repeal

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In identical letters to the Trump Administration and Congress, the American Hospital Association and other state and regional associations are urging members of both branches of the federal government to continue working on legislation to...

Executive Order Calls for ACA Financial, Marketplace Flexibility

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Just hours after taking office, President Trump signed a broad executive order that intends to minimize the “economic burden of the Patient Protection and Affordable Care Act” before an official repeal of the law. Under the executive...

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