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

Claims Reimbursement

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

February 15, 2018 - Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the National Bureau of Economic Research uncovered. Researchers reported that hospitals penalized under the Hospital Readmission Reduction Program (HRRP) and the...


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Medicare Wellness Visit Adoption Boosts Primary Care Revenue

by Jacqueline Belliveau

Practices that performed Medicare wellness visits on at least a quarter of their patients earned greater primary care revenue, experienced more patient assignment stability, and treated patients who were slightly healthier, a new Health Affairs...

How the Bipartisan Budget Act of 2018 Impacts Claims Reimbursement

by Jacqueline Belliveau

After facing two government shutdowns this year, Congress passed a long-term budget deal and President Trump signed it into law early on Feb. 9, 2018. While the Bipartisan Budget Act of 2018 included plans for avoiding another shutdown and increasing...

CMS Opens Low Volume Appeals Settlement to Reduce Appeals Backlog

by Jacqueline Belliveau

In the face of a growing Medicare appeals backlog, CMS opened the first round of a low volume appeals settlement on Feb. 5 for providers with less than 500 claim denial appeals stuck in the appeals backlog at the Office of Medicare Hearings and...

85% of Hospitals to See Part B Increase Despite 340B Payment Cuts

by Jacqueline Belliveau

EDITOR'S NOTE: This article has been updated with a statement from the American Hospital Association. Approximately 85 percent of hospitals will receive a net increase in their total Medicare Part B reimbursements despite recent Outpatient...

AHA, AMA and Others Offer 5 Prior Authorization Reform Strategies

by Jacqueline Belliveau

Six industry groups representing providers, payers, and pharmacists recently partnered to identify strategies to improve prior authorization processes, such as decreasing the number of providers subject to prior authorizations and automating...

Reimbursement Shortfalls, Uncompensated Care Costs Grew in 2016

by Jacqueline Belliveau

Medicaid and Medicare reimbursement in 2016 was $68.8 billion short of actual hospital costs for treating beneficiaries, according to data from the American Hospital Association (AHA). The information from the AHA’s Annual Survey of Hospitals...

Judge Denies Hospital Org Attempt to Block 340B Drug Payment Cut

by Jacqueline Belliveau

A federal judge recently ruled that CMS can start to reduce 340B drug payments to hospitals by $1.6 billion starting on Jan. 1, 2018, striking a blow to several industry groups that urged the court to delay enforcement of the new rule. US District...

AHA Opposes Medicare Reimbursement Cut for Early Hospice Care

by Jacqueline Belliveau

Congress should not pass a proposed policy to reduce Medicare reimbursement rates to hospitals discharging patients to hospice care earlier than the expected, the American Hospital Association (AHA) advised. The proposed policy builds on a 2013...

Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories

by Jacqueline Belliveau

From the Quality Payment Program’s launch to the Affordable Care Act debate, the healthcare finance world saw an abundance of change and uncertainty in 2017. In the face of payment reform and political debates, healthcare leaders focused...

CAQH CORE Opens Certification for Electronic Prior Authorization

by Jacqueline Belliveau

CAQH’s Committee on Operating Rules for Information Exchange (CAQH CORE) recently opened the certification process for Phase IV operating rules, which include standard rules for the electronic exchange of administrative data, such as prior...

Family Physicians Slowly Embracing Value-Based Reimbursement

by Jacqueline Belliveau

Slightly more family physicians are actively pursuing value-based reimbursement opportunities compared to two years ago despite persistent barriers, Humana and the American Academy of Family Physicians (AAFP) recently announced. The survey of...

Medical Billing Codes Do Not Address Full Scope of Primary Care

by Jacqueline Belliveau

Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians in about 60.3 percent of visits, a recent Journal of the American Board of Family Medicine study showed....

CMS Boosts Payments to Hospitals Impacted by Two-Midnight Rule

by Jacqueline Belliveau

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...

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...

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