CMS to Help Medicaid Reimburse for Maternal Opioid Misuse Care
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...More Site-Neutral Payments to Impact Value-Based Care, Reps Says
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...200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule
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...3 Strategies to Minimize the Burden of Prior Authorizations
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...Medicare DSH Payment Case Makes Its Way to the Supreme Court
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...Auditors Recouped $214M in Medicare Improper Payments in 2016
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...Medicare Advantage Plans Overturn 75% of Their Own Claim Denials
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...Clinical Documentation Improvement Solutions Up Provider Revenue
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...AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments
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...Sponsored by symplr
States Look to Streamline Payer Enrollment, Cut Provider Paperwork
Healthcare is a waiting game, with the most common example being the patient waiting room. But patients aren’t the only healthcare stakeholders left waiting. Healthcare organizations oftentimes...Sponsored by symplr
How Automating Payer Enrollment Reduces Time to Reimbursement
Manual claims management processes significantly slow down time to reimbursement. However, payer enrollment services can help healthcare organizations digitize the key claims management step to reduce...Providers Oppose Collapsing Medicare Reimbursement for E/M Visits
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...RCCH Uses Predictive Analytics to Boost Claim Denials Management
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...Sponsored by symplr
