Medicaid Could Save $4.8B Through Electronic Claims Management
State Medicaid programs are significantly lagging with the adoption of fully electronic claim submissions, claim reimbursements, prior authorizations, and other claims management processes, according...Post-Acute Care Providers Worry About Patient-Driven Payment Model
Leading post-acute care associations are expressing concerns with the recently finalized Patient-Driven Payment Model (PDPM), which will tie skilled nursing facility (SNF) reimbursement to value,...CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost
CMS recently finalized a rule that will establish more comprehensive healthcare price transparency rules for hospitals. In the final rules on the Medicare prospective payment systems for the inpatient...CAQH Stresses the Importance of Prior Authorization Automation
CAQH’s Committee on Operating Rules for Information Exchange (CORE) is urging a group of industry leaders to encourage prior authorization automation as part of their efforts to improve the...CMS Moves Medicare Payments for Skilled Nursing Facilities to Value
CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make...Hospital Groups Decry Proposed Outpatient Reimbursement Cuts
Hospitals groups are voicing their concerns with potential site-neutral payments and other outpatient reimbursement reductions proposed in a new rule from CMS. CMS released its proposed CY 2019...Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals
Focusing healthcare payment reforms efforts on providers, rather than hospitals, will be key to lowering healthcare costs, CMS Administrator Seema Verma recently told stakeholders. “Over the...CMS Proposes to Extend Site-Neutral Payments to Clinic Visits
CMS recently proposed to implement site-neutral payments for clinic visits provided at off-campus provider-based hospital departments. According to a recently proposed CY 2019 Medicare Hospital...340B Hospitals Provided Similar Charity, More Uncompensated Care
The debate over whether 340B hospitals truly use discounted prescription drug rates to improve care for vulnerable, low-income patients goes on with a new Government Accountability Office (GAO)...Industry Orgs Fight Anthem’s Emergency Department Payment Policy
The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the...Sponsored by RevSpring
