Reimbursement News

Telehealth Claim Lines Stabilize After Months of Decline

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The percentage of telehealth claim lines has stabilized at about 5 percent of medical claim lines, indicating a new balance of virtual and in-person care. The analysis conducted by FAIR Health as part...

GAO Pushes HHS to Reveal Plans for Unused Provider Relief Funds

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The Government Accountability Office (GAO) is recommending that HHS communicate information of the department’s plans for unused Provider Relief Fund money. A report released publicly on July...

Hospital Pros and Cons of the CY 2022 OPPS Proposed Rule

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The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other...

AI Helps Hospitals Predict DRG-Based Claims Reimbursement, Costs

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Artificial intelligence enabled researchers to accurately predict claims reimbursement based on diagnosis-related group (DRG) shortly after inpatient admission, according to a study published in npj...

The Good and Bad of the Medicare Physician Fee Schedule Proposal

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Physician groups are calling the Medicare Physician Fee Schedule proposed rule a mixed bag for practices, which now face a potential reduction in physician reimbursement next year, among other...

Moving to the Future of Clinical Documentation Improvement

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Clinical documentation has come a long way since the days of paper medical records. Widespread adoption of EHR systems and now EHR optimizations have modernized the act of clinical documentation, and...

340B Drug Payment Case Heads to Supreme Court

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The US Supreme Court recently announced that it will hear an ongoing debate over cuts to 340B drug payments to Medicare hospitals. The case will be heard during the Supreme Court’s upcoming...

Supreme Court Will Not Hear Site-Neutral Payment Case

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The Supreme Court has declined to take up a lawsuit filed by the American Hospital Association (AHA) that aimed to reverse Medicare’s site-neutral payment policy for clinic visits furnished to...

Hospitals Offer Suggestions for Surprise Billing Law Implementation

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With new details on implementation of the No Surprises Act slated to come in early July, the Federation of American Hospitals (FAH) has offered several suggestions for combatting surprise billing to...

Providers Still Want More Time to Spend COVID-19 Relief Funds

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The American Hospital Association (AHA) is seeking more time for healthcare providers with unspent COVID-19 relief funds. The deadline to use COVID-19 relief funds is approaching for many providers....

HRSA: Over 5M Claims Paid for Uninsured COVID-19 Vaccinations

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The Health Resources and Services Administration (HRSA) has paid over 5 million claims for COVID-19 vaccinations of uninsured Americans, according to a recent announcement. The claims were paid...

AMA Calls for Suspension of Prior Auths During PHEs, Better Peer Reviews

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Payers should temporarily suspend prior authorization requirements during public health emergencies (PHEs), according to a new policy from the American Medical Association (AMA). Physicians have faced...

CMS Increases Medicare Payments for At-Home COVID-19 Vaccinations

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Medicare payments will increase by $35 per dose for providers who administer at-home COVID-19 vaccinations for Medicare beneficiaries, CMS announced today. In alignment with President Biden’s...

Over Third of Hospital Execs Report Claim Denial Rates Nearing 10%

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Hospital claim denial rates are at an all-time high, signaling a need for better claims denial management, a recent survey from Harmony Healthcare reveals. The healthcare industry has seen a 20 percent...

Before COVID-19, Healthcare Spending Increased by 4.6%

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National healthcare spending continued to grow right before the COVID-19 pandemic hit, increasing by 4.6 percent in 2019 to a total of $3.8 trillion, the American Medical Association (AMA)...

AHA Launches Hospital Revenue and Claims Comparison Tool

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The American Hospital Association (AHA) recently launched the AHA Vitality Index, a data benchmarking tool that provides hospitals with a dashboard to track claims and reimbursements, as well as...

Medicare Claims Data Show Health Disparities in COVID-19 Patients

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Researchers found significant disparities in Medicare fee-for-service beneficiary spending in an analysis of Medicare claims data relating to COVID-19, according to a Centers for Disease Control and...

HHS: $4.8B to COVID-19 Testing Reimbursement for the Uninsured

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Under the Health Resources and Services Administration (HRSA), HHS announced it will allocate $4.8 billion to COVID-19 testing reimbursement for the uninsured as part of the American Rescue...

Site-Neutral Payment Case Lacks Merit, HHS Tells Supreme Court

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HHS is asking the Supreme Court to bypass a case brought on by hospital groups challenging site-neutral payment rates for certain outpatient evaluation and management (E/M) services, which the...

Medicare Payment Bumped for COVID-19 Antibody, At-Home Infusions

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CMS has raised the Medicare payment rate for certain COVID-19 antibody infusions and included a new payment policy for at-home administration, which will have a higher payment rate compared to other...