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

CMS

Data Sharing Critical to Value-Based Purchasing, HHS Leaders Say

February 13, 2019 - To move the industry to value-based purchasing, healthcare leaders are putting healthcare data sharing and interoperability high on their priority lists in 2019. “Technology, and the sharing of data, underpin the entire move to innovative payment mechanisms in healthcare,” CMS Administrator Seema Verma emphasized at this year’s HIMSS conference in Orlando....


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Congress Wants More on CMMI Alternative Payment Model Development

by Jacqueline LaPointe

The House Committee on Ways and Means is calling on CMS to boost transparency with alternative payment model development in the Center for Medicare and Medicaid Innovation (CMMI), which develops and operates alternative payment and care...

CMS Overhauls MSSP by Finalizing Pathways to Success for ACOs

by Jacqueline LaPointe

CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), which will require accountable care organizations (ACOs) to assume downside financial risk sooner. The MSSP is the largest Medicare ACO program, boasting...

Should Medicare Accrediting Organizations Also Provide Consulting?

by Jacqueline LaPointe

CMS is questioning if the financial relationships between Medicare accrediting organizations and providers are impacting the accreditors ability to accurately determine if providers are fit to participate in the largest public payer. Many...

55% of Hospitals Earn Incentive in Value-Based Purchasing Program

by Jacqueline LaPointe

More hospitals participating in the Hospital Value-Based Purchasing (VBP) Program will see a Medicare payment increase in 2019, CMS recently reported. The Hospital Value-Based Purchasing Program adjusts Medicare reimbursement to hospitals...

CMS Advances Healthcare Price Transparency With Comparison Tool

by Jacqueline LaPointe

CMS is advancing its healthcare price transparency efforts through a new online tool that allows healthcare consumers to compare Medicare payments and copayments for certain surgical procedures. The recently launched Procedure Price...

92% of Providers Concerned About Hospital Price Transparency Rule

by Jacqueline LaPointe

Ninety-two percent of healthcare providers are concerned about the new hospital price transparency requirement recently finalized by CMS, a new poll shows. CMS finalized the hospital price transparency requirement in the 2019 Inpatient...

CMS Commits to Modernizing Medicare Billing for Office Visits

by Jacqueline LaPointe

Finalizing the consolidation of Medicare billing codes for evaluation and management (E/M) outpatient and office visits is the first step for CMS as the federal agency modernizes the payment structure for office visits, CMS Administrator...

AHA, AAMC to Challenge Site-Neutral Payment Policy in Court

by Jacqueline LaPointe

The American Hospital Association (AHA), along with the Association of American Medical Colleges (AAMC) and their member hospitals, plan to bring a lawsuit against CMS for recently released site-neutral payment rules for hospital clinic...

Site-Neutral Payments for Hospital Clinic Visits Starting in 2019

by Jacqueline LaPointe

Hospitals will face site-neutral payments for clinic visits, but not for new clinical families of services, according to the new final 2019 Hospital Outpatient Prospective Payment System (OPPS) rule. CMS recently finalized the contentious...

CMS Delays Collapsing of E/M Payment Rates Until 2021

by Jacqueline LaPointe

CMS will collapse evaluation and management (E/M) payment rates, but not until the 2021 calendar year, according to the recently released final 2019 Physician Fee Schedule (PFS) rule. After industry pushback, the federal agency will delay...

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...

CMS to Extend Healthcare Price Transparency to Prescription Drugs

by Jacqueline LaPointe

CMS is attempting to extend healthcare price transparency to prescription drugs. According to a recently proposed rule, drug manufacturers may have to start including the list price for the medications they advertise on television. As...

CMS Clarifies Healthcare Price Transparency Rules for Hospitals

by Jacqueline LaPointe

CMS recently expanded on new healthcare price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the...

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...

CMS Floats Rule to Save Providers $1.1B, Cut Administrative Burden

by Jacqueline LaPointe

Healthcare providers are slated to save an estimated $1.12 billion annually under a recently proposed rule from CMS that would reduce administrative burdens. The savings would stem from proposals to simplify and streamline...

CMS to Offer More Flexibility to Risk-Bearing ACOs, Verma Says

by Jacqueline LaPointe

Federal regulations and rules are commonly cited as barriers to implementing value-based reimbursement models. The rules can prevent care coordination and appropriate transitions of care, which negatively impact an accountable care...

Next Generation ACOs Save Medicare $62M, Maintain Care Quality

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Next Generation ACO program produced nearly $62 million in net savings to Medicare while maintaining care quality in 2016, CMS recently reported in the newly released evaluation of the...

CMS Initiative to Create Pediatric APMs to Address Opioid Crisis

by Jacqueline LaPointe

A new CMS Innovation Center initiative will call on local stakeholders and Medicaid agencies to develop alternative payment models that address the impact of the opioid crisis for children, CMS recently announced. Medicaid and local...

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