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

Claims Reimbursement

When Claims Reimbursement Doesn’t Cover Healthcare Innovation

by Jacqueline LaPointe

Implementing healthcare innovations that improve care quality is key to boosting patient experience and care quality, but what happens when claims reimbursement doesn’t cover the use of the latest and greatest services? This is the...

HHS to Clear Medicare Appeals Backlog by 2022, Court Docs Show

by Jacqueline LaPointe

HHS is making significant progress with eliminating the growing Medicare appeals backlog, according to recent court documents. The federal department projects Medicare to clear the backlog by the 2022 fiscal year. A 70 percent increase in...

Medicaid Could Save $4.8B Through Electronic Claims Management

by Jacqueline LaPointe

State Medicaid programs are significantly lagging with the adoption of fully electronic claim submissions, claim reimbursements, prior authorizations, and other claims management processes, according to a new Council for Affordable Quality...

Post-Acute Care Providers Worry About Patient-Driven Payment Model

by Jacqueline LaPointe

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, rather than therapy volume. CMS issued the...

CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost

by Jacqueline LaPointe

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 (IPPS) and long-term care (LTCH PPS)...

CAQH Stresses the Importance of Prior Authorization Automation

by Jacqueline LaPointe

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 entire prior authorization process. The...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value

by Jacqueline LaPointe

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 the move by implementing the...

Hospital Groups Decry Proposed Outpatient Reimbursement Cuts

by Jacqueline LaPointe

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 Outpatient Prospective Payment System (OPPS)...

Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals

by Jacqueline LaPointe

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 coming months, we will create new...

CMS Proposes to Extend Site-Neutral Payments to Clinic Visits

by Jacqueline LaPointe

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 Outpatient Prospective Payment System (OPPS)...

340B Hospitals Provided Similar Charity, More Uncompensated Care

by Jacqueline LaPointe

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) report. GAO found that the median amount of...

Industry Orgs Fight Anthem’s Emergency Department Payment Policy

by Jacqueline LaPointe

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 payer to retroactively deny emergency...

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

by Jacqueline LaPointe

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...

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...

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...

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...

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...

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...

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...

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