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

Claims Reimbursement

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

July 12, 2018 - 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 clinicians 51 hours per year if 40 percent of their patients are in Medicare, while proposed changes to the Quality Payment Program would collectively save...


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ESRD Orgs May See Higher Medicare Reimbursement, Drug Payments

by Jacqueline LaPointe

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 ESRD...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH

by Jacqueline LaPointe

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 State...

CMS Proposes New Grouping Model for Medicare Home Health Payments

by Jacqueline LaPointe

CMS recently proposed a rule that would implement the Patient-Driven Groupings Model for Medicare home health payments by 2020. The rule would eliminate the current Medicare reimbursement system for home health agencies, which pays home health...

NJ Passes Medicaid Reimbursement Cap on Non-Emergent ED Services

by Jacqueline LaPointe

Hospital emergency departments are one of the most expensive care settings, and New Jersey policymakers are trying to ensure providers only get paid for delivering emergency services to patients who truly need them. The Garden State’s Assembly...

How Part B Drug Changes Could Impact Provider Reimbursement

by Jacqueline LaPointe

Healthcare industry experts are warning the Trump Administration that its proposal to transfer some drugs covered by Medicare Part B to Part D would have a negative impact on provider reimbursement and care quality. In the Trump Administration’s...

AHA Finds Flaws with the Patient-Driven Payment Model for SNFs

by Jacqueline LaPointe

CMS is in the process of redesigning Medicare reimbursement systems for post-acute care facilities, but the American Hospital Association (AHA) is taking issue with the federal agency’s latest attempt to tie skilled nursing facility (SNF)...

Healthcare Claims Management Market to Reach $13.9B by 2023

by Jacqueline LaPointe

The global healthcare claims management market is slated to reach $13.93 billion by 2023, up from a valuation of $10.16 billion in 2017, MarketsandMarkets recently reported. The significant projected growth in the healthcare claims management...

AMIA Calls for Activity Reporting in Promoting Interoperability

by Jacqueline LaPointe

CMS should replace process measure reporting in the new Promoting Interoperability program with activity-based reporting as in the Improvement Activities performance category of Merit-Based Incentive Reporting System (MIPS), the American Medical...

Federal Policies to Decrease Hospital Payments by $218B by 2028

by Jacqueline LaPointe

Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed. The report commissioned by the Federation...

Electronic Claims Management Adoption Could Save Providers $9.5B

by Jacqueline LaPointe

Transitioning from manual to fully electronic claims management would save the healthcare industry $11.1 billion annually, with providers seeing the greatest share of the savings, the fifth annual CAQH Index found. Providers would save approximately...

Oncologist Org Fights Medicare Reimbursement Cut to Cancer Drugs

by Jacqueline LaPointe

A group representing over 5,000 independent, community-based oncologists is suing HHS over the implementation of a two percent sequester cut to Medicare reimbursement for Part B cancer drugs. The Community Oncology Alliance (COA) is arguing that...

CMS Proposes New Pre-Claim Review for Home Health Agencies

by Jacqueline LaPointe

CMS is floating the idea of implementing another pre-claim review of Medicare claims submitted by home health agencies in at least five states, according to a recent notice of proposed information collection. The federal agency proposed that...

Expanded Resolution Process Opens to Lower Medicare Appeals Backlog

by Jacqueline LaPointe

HHS recently announced an expanded alternative dispute resolution process that aims to reduce the growing Medicare appeals backlog. The expanded Settlement Conference Facilitation (SCF) process promises to streamline Medicare dispute resolutions...

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt

by Jacqueline LaPointe

CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is lacking. According...

Hospitals Wait 16 More Days for Late Payments from Claim Denials

by Jacqueline LaPointe

Delayed payments stemming from claim denials are significantly impacting hospital revenue cycles, taking an average 16.4 more days to pay compared to claims that have not been denied, a new analysis from Crowe Horwath revealed. The analysis of...

CMS to Up Medicare Payments, Reduce Burdens for Inpatient Rehabs

by Jacqueline LaPointe

CMS is seeking to reduce the administrative burden for inpatient rehabilitation facilities on top of a proposed $75 million Medicare payments increase in the 2019 fiscal year. The federal agency released several proposed rules for post-acute...

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

by Jacqueline LaPointe

CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven Payment...

Rural Hospitals Get Low-Volume, Medicare-Dependent Funds Extended

by Jacqueline LaPointe

While the recent 2019 Medicare Inpatient Prospective Payment System (IPPS) rule brought major changes to healthcare price transparency and meaningful use, the rule also extended two key payment programs for small and rural hospitals. Those programs...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

by Jacqueline LaPointe

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new alternative payment...

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