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

Policy & Regulation News

Providers Pay Millions to Resolve Medicare Fraud Cases

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Healthcare fraud, abuse, and waste can cost the government millions, but recently, federal agencies have made catching and preventing Medicare fraud a top priority. Last month, the Department of Justice partnered with the Department of Health...

AHA: Healthcare Fraud Laws Impede Value-Based Care Success

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For alternative payment models under MACRA to succeed, the federal government needs to revise healthcare fraud and abuse prevention laws to work with new value-based care strategies, explained the American Hospital Association (AHA) in a recent...

House Reps Ask for FFS Waivers for Alternative Payment Models

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CMS should make it easier for fee-for-service providers to get involved in risk-based alternative payment models by reducing regulatory barriers, House representatives said in a letter this week. The seventy representatives asked CMS to waive...

CMS Selects 200 Groups for Value-Based Care Oncology Model

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The Centers for Medicare and Medicaid Services (CMS) has announced that almost 200 physician groups and 17 health insurance companies will join the Oncology Care Model, a value-based care program starting in July for providers who furnish chemotherapy...

Finding a Place for Bundled Payments in MACRA Implementation

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As officials at the Centers for Medicare and Medicaid Services (CMS) sift through over 3,800 comments on the proposed rule for MACRA implementation, the Healthcare Incentives Improvement Institute (HCI3) has released its comment letter to CMS...

AMA Voices Concerns Over MACRA Implementation, MIPS, APMs

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As the comment period for the proposed Medicare Access and CHIP Reauthorization Act (MACRA) came to a close earlier this week, the American Medical Association (AMA) expressed some concern with MACRA implementation and its specific Medicare payment...

CMS Targets Medicare Payment Reform for Home Health

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By 2017, home health agencies could see a 1.0 percent, or $180 million, reduction in reimbursements due to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that mandates Medicare payment reform. In a recent fact sheet,...

CMS: Proposed Changes to Dialysis, ESRD Claims Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) has recently announced proposed changes to claims reimbursement models for end-stage renal disease (ESRD) and dialysis as well as revisions to the competitive bidding program for durable medical...

House Reps Introduce Healthcare Transparency, Cost Info Bill

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With more individuals covered by a health insurance plan and high-deductible arrangements on the rise, patients and beneficiaries are increasingly demanding more healthcare transparency when it comes to costs of services and out-of-pocket expenses....

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

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The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on competitive...

CMS Proposes Revisions to Medicaid Improper Payment Programs

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The Centers for Medicare and Medicaid Services (CMS) is calling on healthcare stakeholders to comment on a proposed rule that would change how states identify improper payments stemming from Medicaid and Children’s Health Insurance Program...

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

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The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues with...

Uncompensated Care Drops by $6B after Medicaid Expansion

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Numerous individuals seek necessary medical services at hospitals regardless the ability to pay, but uncompensated care costs from charity cares and patient debt can strain hospital revenue cycles. However, as states develop Medicaid expansion...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

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A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week, Medicare reimbursement...

CMS Announces Pre-Claims Reimbursement Review for Home Health

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In efforts to combat Medicare fraud and provide more timely care to beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has issued a rule that requires some home health agencies to undergo a pre-claim review to qualify for full...

Coding Productivity Fell by 14% After ICD-10 Implementation

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As the anniversary of ICD-10 implementation approaches, a survey from the American Health Information Management Association (AHIMA) Foundation has revealed that coding productivity and accuracy has marginally declined since ICD-10 began. “Health...

60% of RAC Reviewed Claims Showed No Medicare Overpayments

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Reducing healthcare fraud, waste, and abuse has recently been on the top of the CMS agenda, but some healthcare providers are questioning how effective some CMS initiatives are at identifying potential Medicare overpayments. The American Hospital...

Medicare Payment Reform Bill for Hospitals Moves to Senate

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The House of Representatives recently passed the Helping Hospitals Improve Patient Care Act, which proposes Medicare payment reform for off-campus hospital outpatient departments, hospitals with excessive readmissions, and rural hospitals. The...

New DMEPOS Prices Reduce Medicare Spending, Ensure Care Access

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Riding on the success of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), CMS has announced that expanding competitive bidding prices for DMEPOS items nationwide has continued to reduce...

OIG: CMS Lacked Good Management Policies for Pioneer ACO Model

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The Pioneer Accountable Care Organization (ACO) program faced a number of management and leadership challenges during its early days, according to a report from the Office of the Inspector General (OIG).  The report indicates CMS faced several...

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