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

Policy & Regulation News

DOJ Charges 3 Individuals in $1B Medicare Fraud Scheme


Healthcare fraud, waste, and abuse is known to drain the industry of essential funds, but three individuals have allegedly participated in Medicare fraud and money laundering schemes that have cost the program more than $1 billion. According...

CMS Saves $42B Through Healthcare Fraud Prevention Activities


By using a more proactive approach to healthcare fraud protection, CMS has saved the Medicaid and Medicare programs nearly $42 billion in fiscal years 2013 and 2014. In a post on its official blog, CMS attributed the savings to an increase in...

Is MACRA a True Doc Fix for Value-Based Reimbursement?


Will MACRA be the answer to tying reimbursements to quality care or will it be just end up as another doc fix, like those under the Sustainable Growth Rate program? A recent National Center for Policy Analysis report is critical of proposed MACRA...

Medicare ACOs Reduce Healthcare Spending On Complex Patients


While one of the primary goals of joining an accountable care organization (ACO) is to coordinate care in effort to reduce healthcare spending, many Medicare ACO participants have seen early benefits from the alternative payment model. According...

End-of-Life Medicare Spending 25% Higher for Younger Seniors


For most providers, it is not surprising that Medicare spending tends to increase in the last year of a beneficiary’s life, especially since this population is more likely to experience a serious illness and multiple chronic conditions....

AHIMA Reviews Top ICD-10 Implementation, Coding Challenges


In the days leading up to the go-live of ICD-10 implementation, many healthcare providers feared that the new system would decrease productivity and cause more claim denials. However, in the eight months since the launch, most healthcare providers...

Deloitte: Only Half of Physicians Have Heard of MACRA


Despite the significance of its provisions, many healthcare providers are still unaware of MACRA and the federal government's plans to eliminate the sustainable growth rate and offer new alternative payment models to eligible clinicians beginning...

FTC: States Should Avoid Agreement Laws on Hospital Mergers


The Federal Trade Commission has made clear its stance on certain state laws governing hospital mergers while at the same time dismissing a complaint against the merger of Cabell Huntington Hospital and St. Mary’s Medical Center. The federal...

CMS Proposes Medicare Payment Reform Rule for Primary Care


In efforts to better support primary care physicians, CMS has announced a proposed Medicare payment reform rule that would improve payment accuracy for providers who treat chronically ill and medically complex patients. The rule would update...

CMS Proposes to Update Medicare Reimbursement Rates for OPPS


According to a press release, CMS has proposed changes to Medicare reimbursement rates and policies in the Hospital Outpatient and Ambulatory Surgical Centers prospective payment systems. The agency stated that the proposals account for stakeholder...

Providers Pay Millions to Resolve Medicare Fraud Cases


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


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


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


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


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


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


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


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


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


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...


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