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

Claims Reimbursement

CMS Shifting Home Health to Value-Based Payments Under New Model

by Jacqueline LaPointe

CMS recently finalized a new value-based payment system for home health agencies that would move Medicare reimbursement away from the volume of therapy delivered. Medicare will start to reimburse home health agencies under the...

Potential Medicare Reimbursement Demo to Lower Part B Drug Prices

by Jacqueline LaPointe

In an effort to control prescription drug prices, HHS is proposing a mandatory demonstration that would test a new Medicare reimbursement model for certain physician-administered drugs payable under Part B. The proposed International...

CMS to Help Medicaid Reimburse for Maternal Opioid Misuse Care

by Jacqueline LaPointe

CMS recently announced that it will be awarding up to $64.6 million to 12 state Medicaid agencies to help develop Medicaid reimbursement and care delivery strategies for maternal opioid misuse treatment. The awards are part of the new...

More Site-Neutral Payments to Impact Value-Based Care, Reps Says

by Jacqueline LaPointe

Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019. The Oct. 18, 2018 letter to CMS...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule

by Jacqueline LaPointe

About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows. The 200...

3 Strategies to Minimize the Burden of Prior Authorizations

by Jacqueline LaPointe

Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers...

Medicare DSH Payment Case Makes Its Way to the Supreme Court

by Jacqueline LaPointe

The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request from HHS to revisit an appellate...

Auditors Recouped $214M in Medicare Improper Payments in 2016

by Jacqueline LaPointe

Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned...

Medicare Advantage Plans Overturn 75% of Their Own Claim Denials

by Jacqueline LaPointe

A new report from the HHS Office of the Inspector General (OIG) reveals “widespread and persistent problems” related to prior authorization and claim denials in Medicare Advantage. Using Medicare Advantage data on denials,...

Clinical Documentation Improvement Solutions Up Provider Revenue

by Jacqueline LaPointe

Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of healthcare executives, medical records...

AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments

by Jacqueline LaPointe

CMS should withdraw new proposals to expand site-neutral payments to hospital outpatient clinic visits and services from expanded clinical families delivered at off-campus provider-based departments (PBDs), the American Hospital...

Providers Oppose Collapsing Medicare Reimbursement for E/M Visits

by Jacqueline LaPointe

Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5 visits. In a recently proposed rule for...

RCCH Uses Predictive Analytics to Boost Claim Denials Management

by Jacqueline LaPointe

Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue Cycle at Tennessee’s RCCH...

AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment

by Jacqueline LaPointe

The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services. The 2019 CPT code set...

Paying LTCHs Like Skilled Nursing Would Save $4.6B, Analysis Finds

by Jacqueline LaPointe

Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper found. Medicare savings would stem from the...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

by Jacqueline LaPointe

Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a...

Providers Praise E/M Documentation Changes, Oppose Payment Plans

by Jacqueline LaPointe

Physicians and other healthcare professionals recently welcomed proposed evaluation and management (E/M) documentation changes from CMS that would reduce administrative burden and streamline Medicare billing. Specifically, the American...

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