Reimbursement News

Hospital Groups Want Congress to Delay 2% Medicare Sequester Cuts

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UPDATE 12/03/2021: Congress passed a continuing resolution Thursday night, averting a government shutdown. However, it did not address pending cuts to Medicare reimbursement for hospitals and...

HHS Report: State Surprise Billing Laws Offer Limited Protection

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A new report from researchers in HHS' Office of the Assistant Secretary for Planning and Evaluation (ASPE) shows that most states have enacted laws to protect consumers from surprise billing,...

Medicare FFS Improper Payment Rate Hits Low of 6.26%

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CMS continues to control improper payments in Medicare fee-for-service (FFS). The federal agency recently announced that the 2021 Medicare FFS improper payment rate hit a historic low of 6.26 percent...

Automatic MIPS Participation Exemption for Individual Eligible Clinicians

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CMS is exempting all individual eligible clinicians from Merit-Based Incentive Payment System (MIPS) participation in the 2021 performance year (PY). The eligible clinicians will receive an automatic...

Out-of-Pocket Costs Less When Hospitals Don’t Bill Insurance

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A study shows that patients with high deductible plans can save money on out-of-pocket costs by not going through their insurance and paying a reduced cash price. Hospitals must now publish their...

Geisinger to Pay $18M Settlement Over Medicare Billing Violations

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The US Attorney’s Office for the Middle District of Pennsylvania announced that Geisinger Community Health Service (GCHS) reached an agreement to pay more than $18.5 million for...

40% of Charges for COVID-19 Services Initially Ended in Claim Denials

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Providers are having a difficult time billing for services related to COVID-19, with 40 precent of charges for coronavirus-related care initially winding up as claim denials in the first 10 months of...

CMS Updates End-Stage Renal Disease APM, PPS to Address Health Equity

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UPDATED CMS has made changes to the End-Stage Renal Disease (ESRD) alternative payment model, ESRD Treatment Choices, to directly address health equity. The ESRD Treatment Choices (ETC) Model is...

Nearly $27B Remains in Provider Relief Fund, Analysis Shows

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There are still tens of billions of dollars sitting the Provider Relief Fund, a pool of grants specifically for healthcare providers who have reported or are still experiencing pandemic-related losses...

CPT Code Set Adds Code for J&J COVID-19 Vaccine Booster

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The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a new code for COVID-19 vaccine booster doses of the vaccine created by Janssen...

Prior Authorizations Beat COVID Workplace as Top Regulatory Burden

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Prior authorizations are troubling medical groups more than regulations governing the workplace during COVID-19 and Medicare’s Quality Payment Program, according to survey results from the...

High-Impact CARES Act Funds Were Disproportionately Distributed

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Hospitals that had stronger pre-pandemic finances received a disproportionate amount of high-impact funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a JAMA Health Forum...

AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

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The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care...

COVID-19 Hospitalizations Can Cost Over $100K, If Out of Network

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When delivered outside of a patient’s network, COVID-19 hospitalizations can cost hundreds of thousands of dollars depending on where a patient is a treated. California was the most expensive...

Telehealth Reimbursement Needed to Address Demand, Staffing Issues

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Telehealth reimbursement is key to continuing virtual care innovation and addressing healthcare staffing issues at primary care practices, according to a new survey. The survey conducted in mid-August...

Most Group Practices Received Positive MIPS Scores For 2020 Payments

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The majority of group practices that participated in Medicare’s Merit-Based Incentive Program System (MIPS) in 2018 received exceptional or positive performance scores for 2020 payment...

AMA Issues CPT Codes for Pediatric Doses of Pfizer COVID-19 Vaccine

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The American Medical Association (AMA) has issued new Current Procedural Terminology (CPT) codes for pediatric doses of the Pfizer COVID-19 vaccine. In September 2021, Pfizer and BioNTech shared the...

Air Ambulance Prices Rose Substantially for Commercially Insured

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The price for air ambulance transports has risen substantially over the past couple of years, especially for commercially insured patients, according to a recent FAIR Health analysis. The analysis...

Surprise Billing Regulation a Gift to Payers, Blow to Providers

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The American Medical Association (AMA) is calling the latest in a series of surprise billing regulations “an undeserved gift to the insurance industry that will reduce [healthcare] options for...