Reimbursement News

OIG: Improve Medicare rate-setting for clinical diagnostic lab tests

April 12, 2024 - CMS’ procedures for setting Medicare rates for clinical diagnostic lab tests could improve for future public health emergencies, according to a new report from the Office of the Inspector General (OIG). OIG said in the report that, during the COVID-19 public health emergency, current Medicare rate-setting procedures “did not allow the...

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CMS proposes payment increases for IPPS hospitals and LTCHs

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CMS has proposed a 2.6 percent payment rate increase for acute care hospitals paid under the inpatient prospective payment system (IPPS) in FY 2025. The payment update reflects a hospital market...

Skilled nursing facility proposed rule updates payment rates, VBP program

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CMS has released the Skilled Nursing Facility Prospective Payment System (SNF PPS), proposing a payment rate increase, revisions to nursing home enforcement authority, and updates to the quality...

CMS proposes 2.8% payment rate boost for inpatient rehabilitation facilities

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CMS has proposed to increase payment rates for inpatient rehabilitation facilities (IRFs) by 2.8 percent in 2025. The payment update in the IRF Prospective Payment System (PPS) reflects a market...

Hospital financial performance off to a strong start

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Hospital financial performance has stayed strong through the beginning of the year, according to the latest data from healthcare consulting firm Kaufman Hall. The latest “National Hospital Flash...

Private payers initially deny nearly 15% of medical claims

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It may take some time to get paid for medical services, suggests a new survey of hospitals, health systems and post-acute care providers. Nearly 15 percent of medical claims submitted to private...

Hospital payment cap slashes prices in Ore.

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An effort to reduce healthcare spending in Oregon has successfully lowered hospital prices and variation, according to a recent study in Health Affairs. Oregon implemented a cap on hospital prices in...

$460B spending bill averts shutdown, some physician pay cuts

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Congress narrowly avoided a partial government shutdown, sending a $460 billion spending bill to the President’s desk over the weekend. The bipartisan deal, passed by the House 339-85 last...

Hospital Groups Rally Against HHS’ Interpretation of DSH Payments Formula

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The American Hospital Association (AHA) and five other hospital groups are calling on the Supreme Court to challenge the Department of Health and Human Services’ (HHS) interpretation of...

Understanding the Basics of Bundled Payments in Healthcare

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The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment...

House Bill Addresses Price Transparency, Site-Neutral Payment Policies

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The US House of Representatives has passed a bill to improve healthcare price transparency and establish site-neutral payment policies for drug administration. The Lower Costs, More Transparency Act...

Providers See Fourfold Increase in External Payer Audits

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2023 has been a big year for healthcare revenue integrity, with teams managing about four times more external payer audits in the last year. The finding from the latest “MDaudit Annual Benchmark...

How Many Medicare Part D Claims Are Subject to 340B Discounts?

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The share of Medicare Part D claims eligible for discounts in the 340B drug pricing program increased from 1.7 percent to 9.6 percent between 2013 and 2020, a study published in JAMA Health Forum...

Medicare Advantage Denials Jump 56%, Commercial Denials 20%

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Hospitals and health systems have seen a significant spike in claim denials as Medicare Advantage and commercial payers deny more of their reimbursement. A new analysis of data from over 1,300...

How Did Commercial Payments for COVID-19 Inpatient Stays Vary in 2020?

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Commercial payments for inpatient stays associated with COVID-19 in 2020 were higher for health system-affiliated and high-quality hospitals, a study published in JAMA Health Forum found. When the...

Surprise Billing Proposals Aim to Streamline IDR Process

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The Biden-Harris Administration has released a proposed rule to improve the independent dispute resolution (IDR) process for surprise billing by addressing payer-provider communication and adjusting...

Patient Access, Registration Errors Lead to Most Claim Denials

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Hospitals and health systems are facing more claim denials as front-end revenue cycle processes lead to errors. A recent survey conducted by the Healthcare Financial Management Association’s...

Reducing Barriers to MIPS, Advanced APMs Could Promote Participation

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Reducing barriers to Advanced Alternative Payment Model (APM) participation for physicians in rural areas could help promote value-based care and control rising Medicare spending, according to research...

Physician-Owned Hospitals Could Save Medicare Over $1B

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Physician-owned hospitals treated some of the most expensive Medicare beneficiaries at lower costs compared to traditional hospitals despite seeing similar patient populations, according to a recent...

Lower Payment Rates May Help Curb Medicare Spending on Post-Acute Care

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As Medicare Part A is expected to become insolvent by 2033, Congress should reduce Medicare spending on post-acute care by lowering payment rates to skilled nursing facilities (SNFs), home healthcare...

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