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

Policy & Regulation News

Examining the Value-Based Alternative Payment Model Basics


Alternative payment models like the accountable care organization (ACO) and the bundled payment model have been gaining popularity under the Affordable Care Act’s (ACA) mandates. Figuring out how alternative payment models will evolve under...

CMS Provider Data Combats Medicare, Medicaid, CHIP Fraud


To help combat healthcare fraud, the Centers for Medicare & Medicaid Services (CMS) has released a new pair of public data sets to promote greater Medicare and Medicaid data transparency and cut down on Medicare and Medicaid fraud,...

Price Transparency Still Missing from Hospital Revenue Cycle


The Affordable Care Act’s (ACA) numerous price transparency provisions are inefficient, says a policy brief from the Pioneer Institute. Hospital executives must make consumer-friendly pricing information a top revenue cycle focus or else...

2 Medicare Alternative Payment Models Demanding Future Focus


Medicare alternative payment models have the ability to make affordable, high quality care a reality. But providers still demand greater levels of care coordination and cleaner streamlining of clinical data to achieve value-based reimbursement...

CMS Rule Addresses Medicare Fraud, Overpayment Compliance


The Centers for Medicare & Medicaid Services (CMS) published a final rule this week focused on improving Medicare compliance, reporting, and self-identified overpayments to ultimately combat Medicare fraud. Under...

The Affordable Care Act’s Effect on Hospital Charity Care


Hospitals provide charity care according to patients’ income levels. But policies and patient criteria often vary depending on the particular hospital. Supporting hospital charity care while maintaining tight margins is a challenge, especially...

Medicare Advantage Value-Based Care Arrangements Up Revenue


Healthcare providers have yet to recognize the significant yet untapped potential of Medicare Advantage value-based care arrangements to increase revenue, according to a study from Deloitte.  Health plans are apparently stressed,...

CMS Says Alternative Payment Models Still Have a Way to Go


Leading healthcare experts are speaking out about whether or not the healthcare industry is making progress in regard to alternative payment models. The healthcare industry is apparently on the right track thus far. Thirty percent of all Medicare...

CMS Reports SNF Payment Incentives May Cut Medicare Spending


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...

AHA: Stark Law Exception Advances Alternative Payment Models


Congress should focus on improving federal fraud and abuse laws, said the American Hospital Association (AHA) to the Senate Finance and House Ways and Means Committee last week. The AHA advocated for an exception to be created under the anti-kickback...

Affordable Care Act Creates Tax-Funded Expenditure Majority


Over 64 percent of healthcare spending is tied to tax-funded expenditures, according to new data from the American Journal of Public Health. This reported number apparently contradicts commonplace perceptions about the cost of healthcare. Researchers...

CMS Tackles Medicare Spending, Medicaid Financial Incentives


Medicare and Medicaid spending demands closer alignment for healthcare providers to better manage costs, according to a new report from the Centers for Medicare & Medicaid Services (CMS). A CMS/state partnership Capitated...

Revenue Cycle Management a Post-ICD-10 Implementation Focus


Healthcare organizations are focused on strengthening revenue cycle management processes in a post-ICD-10 environment, according to Porter Research and Navicure’s national ICD-10-centered survey. As the concluding chapter of a...

CMS Makes Revisions to Medicare Prospective Payment System


The Centers for Medicare and Medicaid Services (CMS) is making changes to the Medicare hospital inpatient prospective payment systems (IPPS). CMS says it is modifying 2016’s IPPS Pricer to reflect a new payment calculation adjustment...

55 Hospitals File Two-Midnight Rule Lawsuit Against HHS


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...

CMS’s Medicare Drug Spending Dashboard Notes Spending Spike


The Centers for Medicare & Medicaid Services (CMS) has released a Medicare Drug Spending dashboard to address prescription drugs’ affordability. CMS aims to make drug spending trends more transparent for healthcare providers. CMS...

Why Chronic Illness is Threatening the Healthcare Industry


1 in 4 primary care physicians feel dangerously ill-equipped to successfully handle and coordinate care for some of their most challenging patients, such as those with chronic conditions, severe mental illness, and those in need of long-term...

AMA, CMS Lead Discussion on Evolving Healthcare Market Today


The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) are pairing up to lead a discussion today about the ongoing state of the evolving healthcare market. The discussion will be held at 5PM (PT) at...

CMS, HHS Get Social with $157M in Medicare, Medicaid Funding


The Department of Health and Human Services (HHS) has revealed a new 5-year $157 million funding opportunity this week to help advance the overall quality and affordability of Medicare and Medicaid. The health-related social needs of Medicare...

CMS Tackles Value-Based Purchasing Pilot Program Questions


Competition across the nation for value-based payment incentives is underway with the start of a new year. Nine states, each representing a different geographic region, have implemented the home health value based purchasing pilot program...


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