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

Claims Reimbursement

CMS Boosts Payments to Hospitals Impacted by Two-Midnight Rule

November 21, 2017 - Sixty-seven hospitals affected by the Two-Midnight Rule will receive a boost in Medicare reimbursement on Part A discharges for the next year, a recent CMS notice explained. The notice ordered Medicare Administrative Contractors (MACs) to apply an unspecified interest adjustment factor when calculating Medicare reimbursements for discharges occurring between June 1, 2017, and May 31, 2018....


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House Reps Aim to Stop $1.6B Hospital Payment Cut for 340B Drugs

by Jacqueline Belliveau

A new bipartisan bill intends to block CMS from enforcing a $1.6 billion Medicare reimbursement cut under the 340B Drug Pricing Program. Representatives David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392 last week. The bill would...

KLAS: Quadax, SSI Group Earn Top Scores for Claims Management

by Jacqueline Belliveau

Respondents in a recent KLAS report named Quadax, SSI Group, and ZirMed as the best overall performing claims management vendors because of the high-quality customer service and support provided by the companies. The 296 healthcare organizations...

Hospital Orgs to Sue CMS Over 340B Medicare Reimbursement Cuts

by Jacqueline Belliveau

The American Hospital Association (AHA), America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) recently announced their intentions to pursue litigation against CMS to prevent Medicare reimbursement reductions...

CMS Cancels Home Health Groupings Model, $950M Reimbursement Cut

by Jacqueline Belliveau

CMS recently scrapped the proposed Home Health Groupings Model. The model would have used clinical and patient characteristics rather than the current therapy service use thresholds to determine Medicare reimbursement for home health agencies....

CMS Finalizes 2018 Hospital, Physician Medicare Reimbursement

by Jacqueline Belliveau

In a series of final rules released earlier this month, CMS updated and modified Medicare reimbursement rates for hospitals and physicians in 2018. The rules aim to “reflect a broader Administration-wide strategy to create a healthcare...

29% of Healthcare Payments Under Alternative Payment Models

by Jacqueline Belliveau

About 29 percent of healthcare payments in 2016 were paid through an alternative payment model, such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, the Health Care Payment Learning and Action Network...

AHA: OIG Hospital Audit Extrapolation Led to Excessive Claim Denials

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged CMS to reconsider its extrapolation approach when conducting Office of the Inspector General (OIG) hospital audits because the method leads to excessive repayment requests and claim denials....

Physician Advisors Crucial to Navigating Reimbursement Rules

by Jacqueline Belliveau

When physicians are asked why they went into medicine, the classic response is that they wanted to help people. But as value-based reimbursement takes hold and clinical documentation demands increase, providers are finding that the business of...

Reps Eye Delay for Medicaid Disproportionate Share Hospital Cuts

by Jacqueline Belliveau

Three House Representatives recently called on their Congressional peers to postpone implementing a rule that would reduce Medicaid Disproportionate Share Hospital (DSH) payments starting on Oct. 1, 2017. The bipartisan letter from Representatives...

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues

by Jacqueline Belliveau

Electronic claims management adoption continues to face challenges related to healthcare Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA), a new Workgroup for Electronic Data Interchange (WEDI) white paper explained....

AHA Questions Accuracy of Combined Post-Acute Care Payment System

by Jacqueline Belliveau

CMS and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) should address fundamental issues with the prototype of a combined Medicare post-acute care payment system, a recent Dobson DaVanzo & Associates report stated....

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline Belliveau

In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment for the...

17% of Practices Pay Fees for Electronic Healthcare Payments

by Jacqueline Belliveau

Approximately 17 percent of physician practices are forced to pay a fee for receiving electronic healthcare payments from their payers, with fees ranging between 2 and 5 percent of the total reimbursement, a recent MGMA poll of over 900 medical...

Does the Medicare Physician Fee Schedule Undervalue Primary Care?

by Jacqueline Belliveau

CMS continues to put the revenue of primary care providers at risk by undervaluing codes for primary care and failing to meet the misvalued code target required by law in the proposed 2018 Medicare Physician Fee Schedule update, the American...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline Belliveau

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in an...

AHA: New Skilled Nursing Facility Payment System Needs Development

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged CMS to flesh out a proposal to implement an alternative Medicare reimbursement model for skilled nursing facilities prior to advancing the changes through official rulemaking processes. CMS...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

by Jacqueline Belliveau

The CMS Advisory Panel on Hospital Outpatient Payment recently called on the federal agency to abandon proposed changes to the 340B Drug Pricing Program in 2018, which would reduce Medicare reimbursement to qualifying hospitals for drugs acquired...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

by Jacqueline Belliveau

CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. The federal agency originally introduced the Medicare...

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

by Jacqueline Belliveau

Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers...

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