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

Policy & Regulation News

For Truly Value-Based Care, Use Outcomes Instead of Processes

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Value-based care is the goal of many of the nation’s healthcare reform efforts, yet basing regulatory changes and provider-facing metrics on checking off processes instead of achieving outcomes could be the wrong approach, states a new...

AHA: MACRA Alternative Payment Model Incentives Need Changing

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The MACRA Alternative Payment Model incentives should be implemented in a way that provides the best opportunity for physicians to become qualifying participants, the American Hospital Association argued in a letter to CMS this week MACRA provides...

Expert Seeks Payment Reform in Light of Healthcare Mergers

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Payment reform might be one way to tackle the issue of rising medical costs that have been coming as a result of healthcare mergers. It’s possible for this issue to be resolved if the federal government pursued policies to foster competition...

ICD-10 Implementation Ran Smoother than Originally Expected

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On May 9, the Workgroup for Electronic Data Interchange (WEDI), announced that the ICD-10 implementation process was moderately smooth because costs were mostly in line with expectations and testing improved. Additionally, productivity levels...

GAO: Millions Spent Yearly on Ineligible Medicaid Reimbursements

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Ineligible managed care providers currently receive $3 million in Medicaid reimbursements annually, the Government Accountability Office (GAO) said in a report, due to the lack of effective screening processes. “The integrity of the Medicaid...

Are Healthcare Fraud and Abuse Rates on the Decline?

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If trends persist, 2016 is looking set to have the lowest level of federal prosecutions for healthcare fraud since 1998, according to Transactional Records Access Clearinghouse (TRAC). TRAC, which is a research organization at Syracuse University,...

Providers Collect More Revenue Due to ACA Medicaid Expansion

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In recent years, the Affordable Care Act (ACA) paved the way for significant Medicaid expansion. A recent study from the National Bureau of Economic Research found that Medicaid expansion resulted in financial benefits for low-income patients...

How MACRA, MIPS Will Impact Critical Access Hospitals, FQHCs

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MACRA means different things to various types of healthcare providers, such as critical access hospitals, rural health clinics and Federally Qualified Health Centers. Although the new MACRA framework provides multiple paths to success with various...

Top 5 Facts to Know about MACRA Alternative Payment Models

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CMS recently proposed a rule that would put last year's MACRA's legislation into action. The proposal introduces several significant changes to the way providers will attest to quality improvements and technology use, but also includes...

MACRA Quality Payment Program Promotes Alternative Payment Models

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The newly-proposed MACRA implementation rule establishes the Quality Payment Program and shines a spotlight on alternative payment models for Medicare. Alternative payment models (APMs) are a central feature of new proposed rule for implementation...

CMS Payment Reforms Mean Big Bucks for Medicare, Medicaid

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Over the past month, CMS has announced finalized and proposed rules that would significantly impact payment policies in 2017 for managed care in Medicaid and the Children’s Health Insurance Program (CHIP) as well as Medicare hospice benefits,...

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments

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On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that addresses the problematic two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule would...

CMS Proposes New Quality Reporting for Skilled Nursing Facilities

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CMS is hoping to bring more value-based care to skilled nursing facilities by issuing a proposed rule that raises the bar on quality reporting programs for these providers. As part of the Improving Medicare Post-Acute Care Transformation Act...

AHIMA Proposes Revisions to New Group of ICD-10-PCS Codes

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Six months after the healthcare industry managed to make its initial transition to ICD-10 with few significant issues, CMS is planning to lift its freeze on the addition of new codes. Approximately 5000 new codes will join the existing ICD-10-CM...

Providers Need Time, Resources for MACRA Implementation

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Driven by the Affordable Care Act, the implementation of Medicare Access and CHIP Reauthorization Act (MACRA) is expected to significantly impact the nation's healthcare system. Already, many physicians and various types of healthcare...

Patient Scheduling Still Problematic at VA Medical Settings

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In a perfect world, the Department of Veterans Affairs’ (VA) patient scheduling system works effectively so veterans are able to access primary care physicians easily. Unfortunately, many veterans continue to face extremely long wait times...

House Requests CMS Delay Quality, Value-Based Care Ratings

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A group of 225 members of the House of Representatives recently wrote a letter urging CMS it to delay the release of the hospital star rating system because it does not include relevant quality measures for assessing value-based care and the...

CMS Extends Deadline for Bundled Payment Models Participation

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The federal government especially the Centers for Medicare & Medicaid Services (CMS) have long focused on reducing healthcare spending and implementing alternative payment models such as pay-for-performance initiatives. Bundled payment models,...

States Could Build Upon the Affordable Care Act to Cut Costs

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The Affordable Care Act has had two main goals for the healthcare system: Increase health insurance coverage for Americans and lower healthcare spending around the country. At this point in time, the Affordable Care Act has brought health coverage...

How to Reduce Wasteful Spending in the Medicare Program

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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...

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