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

Policy & Regulation News

MGMA to Price: Simplify MACRA, Reassess Alternative Payment Models

February 15, 2017 - 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 said in an open letter.    President and CEO Halee Fischer-Wright, MD, MMM, FAAP, CMPE, outlined four major objectives that would encourage...


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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...

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

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A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative law judge level. HHS projected the backlog...

HRSA Adds $5K Fines for 340B Prescription Drug Rate Overcharging

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Drug manufacturers participating in the 340B Drug Pricing Program who intentionally charge hospitals prescription drug rates higher than established ceiling prices will face a $5,000 penalty per instance, a new Health Resources and Services Administration...

VA Gives RNs Full Practice Authority to Improve Care Access

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The Department of Veterans Affairs (VA) will now give some advanced practice registered nurses full practice authority in order to boost care access and quality of care. However, certified registered nurse anesthetists will not benefit from expanded...

CMS Hinders Private Plan Steering for Claims Reimbursement Bump

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CMS recently released an interim final rule designed to prevent providers at Medicare-certified dialysis centers from inappropriately steering patients away from Medicare and Medicaid in order to get higher claims reimbursement rates under the...

AHA, FAH: ACA Repeal Could Cost Hospital Revenue Cycle Billions

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Providers could face billions in hospital revenue cycle losses if the Affordable Care Act is repealed without replacement legislation that preserves health coverage increases and rolls back claims reimbursement cuts, stated the American Hospital...

AHA Calls for Value-Based Reimbursement Reform Under Trump

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In a recent letter to President-Elect Trump, the American Hospital Association (AHA) urged the upcoming administration to continue the value-based reimbursement transition by developing more effective alternative payment models, promoting telehealth,...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

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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

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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....

WEDI: ICD-10 Coding Guideline Negates Some Claim Audit Policies

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A new ICD-10 coding guideline conflicts with reporting and auditing policies for several quality programs as well as medical necessity rules and other healthcare regulations, stated the Workgroup for Electronic Data Interchange (WEDI) in a recent...

CMS Finalizes MACRA Implementation, Quality Payment Program

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CMS released the long-awaited final rule on MACRA implementation earlier today, which stated that the new value-based reimbursement system will start on Jan. 1, 2017. The final MACRA implementation rule will replace the Sustainable Growth Rate...

GOP Doctors Caucus Suggests MACRA Implementation Changes

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In a recent letter to CMS Acting Administrator Andy Slavitt and Director of the Office of Management and Budget Shaun Donovan, the GOP Congressional Doctors Caucus called for several MACRA implementation changes to make the value-based reimbursement...

GAO: Healthcare Spending Data from CMS Inaccessible, Unreliable

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CMS should make healthcare spending data for skilled nursing facilities more accessible to public stakeholders and ensure the expenditure information is reliable, the Government Accountability Office (GAO) advised the federal agency in a recent...

House Reps Urge CMMI to Cease Mandatory Payment Reform Models

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In a recent letter to CMS leaders, House representatives urged the federal agency to stop all mandatory payment reform demonstrations through the Center for Medicare and Medicaid Innovation (CMMI), such as the ongoing Comprehensive Care for Joint...

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