CMS recently finalized a rule that aims to streamline the Medicare appeals process and reduce provider burden by eliminating signature requirements for appeal requests.
The rule published on May 7...
April showers bring May flowers. But, this year, they are also bringing a slew of new Medicare payment rate proposals, including reimbursement and quality reporting updates for several types of...
CMS is proposing to update Medicare payment policies under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY)...
The Medicare Board of Trustees still projects the Hospital Insurance (HI) Trust Fund, which supports provider payments under Medicare Part A, will deplete by 2026, according to their 2019 annual...
CMS is seeking a 2.3 percent, or $195 million, increase in Medicare payments to inpatient rehabilitation facilities (IRFs) in the fiscal year (FY) 2020, according to a newly proposed rule.
The...
High costs coupled with a lack of adequate claims reimbursement is challenging the adoption of innovative medical devices and creating tension between providers, supply chain leaders, and revenue cycle...
Medicare and Medicaid are on the Government Accountability Office’s (GAO) list of programs that are at an elevated risk for fraud, waste, abuse, and mismanagement after a recent investigation...
Health payers have not made meaningful progress with prior authorization reform, the American Medical Association (AMA) recently argued following the release of their new physician survey.
The...
President Trump’s budget proposal for the 2020 fiscal year is requesting a tightening of the purse strings for HHS, including $845 billion in Medicare spending cuts over the next decade.
The...
Pennsylvania Governor Tom Wolf recently tapped the first five hospitals and five payers to participate in a new alternative payment model from the CMS Innovation Center that uses all-payer global...
A growing network of post-acute care hospitals based in Pennsylvania recently achieved a near perfect clean claims rate and uncovered $12 million in inappropriate payer denials after switching its...
HHS is reexamining Medicare reimbursement structures in kidney care that encourage more dialysis center treatment, rather than home-based care or even transplants.
HHS Secretary Alex Azar made the...
The Office of the Inspector General (OIG) estimates CMS improperly paid $84 million for post-acute care services that did not meet the skilled nursing facility (SNF) 3-day rule in a recent two-year...
Extending and establishing site-neutral payments for outpatient services is the key to lowering healthcare costs, a coalition of patient advocates, providers, payers, and employers recently told...
Despite higher Medicaid reimbursement, fewer uninsured individuals, and less uncompensated care costs, hospital cost shifting to commercial payers did not subside in Colorado.
Those are the findings...
Robots in healthcare do not have to be large human-like machines that replace providers. But bots embedded in software applications can be a key tool for reducing the burden of mundane, common tasks,...
Thirty-eight hospitals filed a lawsuit against HHS over a $380 million reduction in Medicare reimbursement to hospitals under a new outpatient site-neutral payment policy.
The lawsuit alleges that HHS...
Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index.
The CAQH 2018 Index showed adoption...
Over three-quarters (78 percent) of revenue cycle leaders at acute care organizations agreed charge capture is essential to an organization’s success, yet most leadership teams only discuss...
The largest public payers continue to underpay hospitals, data from the most recent American Hospital Association (AHA) Annual Survey of Hospitals revealed. Medicare and Medicaid reimbursement fell...
