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

Revenue Cycle Management Healthcare News

NY Health System Settles E&M Upcoding, Healthcare Fraud Case

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A New York-based health system will pay the federal government $14.7 million to settle healthcare fraud allegations that claim the system engaged in evaluation and management (E&M) upcoding. According to the Department of Justice (DoJ),...

Court Rejects AHA’s Attempt to Block 340B Hospital Payment Cuts

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A federal appellate court recently tossed the American Hospital Association’s (AHA) lawsuit against HHS, which attempted to block $1.6 billion in 340B hospital payment cuts. Three judges on the US Court of Appeals for the District of ...

Industry Orgs Fight Anthem’s Emergency Department Payment Policy

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The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the payer to retroactively deny emergency depar...

Healthcare Cost Control Rises to Top Hospital Exec Priority

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Healthcare cost control rose to the top of hospital leader priority lists, bypassing revenue growth for the first time, according to the Advisory Board’s most recent Annual Health Care CEO Survey. The survey of 146 C-suite executives ...

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says

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CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been positive...

Docs, Payer Execs Agree Providers Lack Tools for Value-Based Care

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A lack of technology and patient data may be stalling or even reversing the value-based care transition, a new survey of primary care physicians and health plan executives revealed. “Stalled Progress on the Path to Value-Based Care,&r...The survey’s finding is a change from last year’s results, which found that just 45 percent of health plan executives felt providers did not have the tools to succeed. Health plan executives also flipped their views on if the he...The same percentage point gap existed between both groups when asked if they agree or disagree that technological investments for quality initiatives have improved the value of healthcare for patients. Sixty-eight percent of doctors felt in...Approximately one-half of respondents (47 percent) also thought blockchain could help the value-based care transition, with health plan executives being significantly more optimistic about the technology. Sixty-four percent of health plan l...

A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step

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Many hospitals and health systems are bypassing the ultimate opportunity to gain greater control of the outcomes and costs of their patients. That opportunity is developing their own provider-sponsored health plan, according to Geisinger He...“There's a lot of different forms of risk-taking that can occur,” he elaborated. “You can think about it on a final payment basis. You could think about it on a total cost of care basis. The other would be like what we...

Who Should be Held Accountable for Healthcare Costs?

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While the recent growth in patient financial responsibility has providers thinking about healthcare costs when making care decisions, many still do not think they should be held accountable for the costs of care, a recent survey showed. A n...Over 60 percent of the physicians also reported that they are responsible for educating their patients about healthcare costs. However, almost one-half of the respondents said they should not be held accountable for total cost of ...But just 28 percent of healthcare executives, clinician leaders, and clinicians felt individual clinicians had a strong effect on cost of care. Even fewer thought employers (26 percent) and patients (23 percent) made an impact on healthcare...

Beth Israel, Lahey Health Hospital Merger May Up Costs, MA AG Says

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The proposed hospital merger between Beth Israel Deaconess Medical Center and Lahey Health is facing pushback from the Massachusetts Attorney General despite a previous endorsement from a key state board. Local news sources are reporting th...

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

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CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual cl...Additionally, CMS may also start to reimburse clinicians for virtual care under the updated Medicare Physician Fee Schedule. The recently proposed rule would establish reimbursement for virtual check-ins and evaluations of patient-submitted...In the proposed rule, CMS also sought additional stakeholder feedback on a new hospital price transparency requirement. The federal agency is looking for more information on a rule that would require hospitals to make public a list of their...Additionally, the proposed rule would implement changes required under the Bipartisan Budget Act of 2018. Key changes from the act included only applying MIPS payment adjustments to covered professional services under the Physician Fee Sche...

ESRD Orgs May See Higher Medicare Reimbursement, Drug Payments

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A new proposal from CMS would increase Medicare reimbursement to end-stage renal disease (ESRD) facilities by $220 million and change the way the federal agency pays the facilities for new renal dialysis drugs. The proposed update to the ES...With the proposals, Verma intends to “help secure sustainable access to durable medical equipment.” Stakeholders can comment on the proposed changes to the ESRD prospective payment system and the DMEPOS Competitive Bidding Progr...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH

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CMS recently approved a five-year Section 1115 demonstration allowing New Hampshire to provide Medicaid reimbursement to more behavioral health facilities for substance use disorder treatment services. The approval authorizes the Granite St...Expanding access to covered and reimbursable opioid use and substance use treatment services is a key step to improving deteriorating patient outcomes and reducing the costs of treating individuals affected by the disorders. Other stakehold...

Key Terms, Components of Payer Contracts Providers Should Know

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Providers are in the business of keeping their patients healthy. But confusing payer contracts riddled with “legalese” and other complicated provisions can get in the way of improving patient outcomes. Payer contracts define and...

Hospitals to See More 340B Drug Pricing Program Oversight, Azar Says

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According to HHS Secretary Alex Azar, hospitals should expect greater transparency and oversight of the 340B Drug Pricing Program to track how the program’s benefits are used to improve care for low-income and vulnerable populations. ...

CMS Aims to Protect Medicaid Payments to Providers, Not 3rd Parties

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CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed regulatory change to the Medicaid Provider...

Stakeholders Want Greater MIPS Participation for Higher Rewards

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Policymakers and industry groups are calling on CMS to include more Medicare providers in MACRA’s Merit-Based Incentive Payment System (MIPS). Five members of Congress, all of whom are part of the House GOP Doctors Caucus, recently ur...

EHR Costs, Staffing Still Trouble Small, Rural Practices in MIPS

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Financial challenges plaguing small and rural practices under legacy Medicare value-based purchasing programs are likely to persistent under the Merit-Based Incentive Payment System (MIPS), the Government Accountability Office (GAO) recentl...“Since MIPS uses many of the same reporting and measurement mechanisms as the legacy programs, some stakeholders believe that small and rural practices may be less equipped to manage the administrative, technological, and financial bu...

More Execs Expect Value-Based Reimbursement to Up Profitability

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Approximately 46 percent of healthcare executives and managers expect value-based reimbursement contracts to improve their organization’s profitability, according to a recent KPMG survey. Healthcare leaders are more optimistic about t...

CMS Postpones Deadlines for New Bundled Payments Model

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Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced in...

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