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

Policy & Regulation News

CMS Prepares Providers for End of ICD-10 Coding Flexibilities


Starting on October 1, CMS plans to thaw the freeze on ICD-10 implementation by adding more codes and allowing review contractors to deny claims based on level of specificity. To help healthcare providers prepare for updates to ICD-10 coding...

Patients Led to Private Plans to Boost Claims Reimbursement?


The federal agency is investigating whether some healthcare providers or provider-affiliated organizations are encouraging individuals eligible for Medicare and/or Medicaid to enroll in individual market plans under the Affordable Care Act in...

$17B Increase in Medicare Part D Prescription Drug Spending


Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription drug spending...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan


CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal agency. The...

Cardiac Care Bundled Payment Model to Generate Modest Savings


The recently proposed Medicare bundled payment model for cardiac care will likely bring only modest shared savings or losses to participants, according to a study from Avalere Health. About 85 percent of providers that will be required to take...

Value-Based Care Penalties Spark Greater Quality Improvements


Financial penalties may be the key to advancing value-based care goals, such as reducing hospital admissions, according to a recent study in the American Journal of Managed Care. Almost two-thirds of hospital leaders stated that the Hospital...

At-Home Service Value-Based Care Model Saves Medicare $10M


A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending. Medicare saved $10 million during the...

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?


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...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement


States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid pass-through...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States


To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its website. “CMS is continuing its efforts...

CMS Final Rule Updates Inpatient Claims Reimbursement System


Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the Medicare Hospital...

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts


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...

GAO: Medicare Uncompensated Care Aid Not Based on Actual Costs


Medicare’s uncompensated care payments to hospitals do not account for the actual healthcare costs associated with treating large proportions of Medicaid and uninsured patients, according to a recent Government Accountability Office (GAO)...

CMS Opens Enrollment for Value-Based Primary Care Model


CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September 15,...

CMS Issues Final Changes for Medicare Reimbursement Programs


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


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...

How CMS Would Reimburse ACOs for Value-Based Care under MIPS


With a final rule on implementing MACRA coming in the next couple of months, some accountable care organizations (ACOs) have started to analyze new value-based reimbursement structures under the proposed rule. While only a couple of Medicare...

CMS Details Rationale Behind Hospital Quality Ratings


Just as consumers rate restaurants on on a scale of one to five stars, CMS has published star ratings for healthcare facilities on its Hospital Compare website to boost healthcare transparency. According to CMS leadership, the federal...

Healthcare Transparency Bill Proposes to Delay Star Ratings


Two House Representatives, Jim Renacci (R-OH) and Kathleen Rice (D-NY), have recently introduced a healthcare transparency bill that would require CMS to delay the release of new hospital star ratings for another year to ensure that the program’s...

New Rules for Bundled Payment Models for Cardiac, Hip Care


CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25, 2016, the...


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