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

Centers for Medicare & Medicaid Services

CMS Delays Rollout of Cardiac, Ortho Bundled Payment Programs

March 20, 2017 - CMS is pushing back the start date for a number of its bundled payment programs in an effort to provide additional time to review and prepare for the initiatives. In a notice posted in the Federal Register, CMS has issued three-month delays for the start of the Comprehensive Care for Joint Replacement pilot (CJR), the Cardiac Rehabilitation Incentive Payment Model, and three other Medicare...

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Congress Asks CMS to Scrap Prior Authorization for Home Health

by Catherine Sampson

A CMS proposal to require a prior authorization screening for every home health service would be an administrative nightmare and may produce barriers to care for needy patients, a group of 116 lawmakers said in a letter to CMS this week. "This...

OIG: CMS Not Reducing Medicare, Medicaid Improper Payments

by Catherine Sampson

In testimony submitted to House of Representatives Subcommittee on Oversight and Investigations, the Office of Inspector General (OIG) urged the Centers for Medicare & Medicaid Services to work with states to correct gaps in their...

Wisconsin Hospital Questions Hospital Profitability Study

by Catherine Sampson

In a hospital profitability study, researchers from Health Affairs drew the conclusion that Gundersen Lutheran Medical Center earned a profit of $302.5 million, or $4,241 per patient, in 2013. However, Gundersen Lutheran Medical Center claimed...

AHA: MACRA Alternative Payment Model Incentives Need Changing

by Catherine Sampson

The MACRA Alternative Payment Model incentives should be implemented in a way that provides the best opportunity for physicians to become qualifying participants, the American Hospital Association argued in a letter to CMS this week MACRA provides...

How MACRA, MIPS Will Impact Critical Access Hospitals, FQHCs

by Catherine Sampson

MACRA means different things to various types of healthcare providers, such as critical access hospitals, rural health clinics and Federally Qualified Health Centers. Although the new MACRA framework provides multiple paths to success with various...

Top 5 Facts to Know about MACRA Alternative Payment Models

by Catherine Sampson

CMS recently proposed a rule that would put last year's MACRA's legislation into action. The proposal introduces several significant changes to the way providers will attest to quality improvements and technology use, but also includes...

CMS Proposes New Quality Reporting for Skilled Nursing Facilities

by Catherine Sampson

CMS is hoping to bring more value-based care to skilled nursing facilities by issuing a proposed rule that raises the bar on quality reporting programs for these providers. As part of the Improving Medicare Post-Acute Care Transformation Act...

Providers Need Time, Resources for MACRA Implementation

by Catherine Sampson

Driven by the Affordable Care Act, the implementation of Medicare Access and CHIP Reauthorization Act (MACRA) is expected to significantly impact the nation's healthcare system. Already, many physicians and various types of healthcare...


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