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

CMS

CMS to Extend Healthcare Price Transparency to Prescription Drugs

October 16, 2018 - 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 part of its efforts to lower prescription drug costs and healthcare spending, the federal agency proposed to require drug manufacturers to post the...


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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...

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)...

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)...

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 Aims to Protect Medicaid Payments to Providers, Not 3rd Parties

by Jacqueline LaPointe

CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed regulatory change to the Medicaid...

CMS Postpones Deadlines for New Bundled Payments Model

by Jacqueline LaPointe

Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced...

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...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

by Jacqueline LaPointe

In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according to a recent announcement from the...

CMS Accounts for Extreme Situations in CJR Bundled Payments

by Jacqueline LaPointe

CMS updated rules for the Comprehensive Care for Joint Replacement (CJR) bundled payments model to protect participating hospitals from uncontrollable episodes costs incurred during an emergency period, like the recent Hurricanes or...

CMS Proposes New Pre-Claim Review for Home Health Agencies

by Jacqueline LaPointe

CMS is floating the idea of implementing another pre-claim review of Medicare claims submitted by home health agencies in at least five states, according to a recent notice of proposed information collection. The federal agency proposed...

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