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

CMS

61% of Next Generation ACOs Earned Shared Savings in 2016

October 17, 2017 - The majority of Next Generation Accountable Care Organizations (ACOs) earned shared savings in the first year of the model, recent data from CMS revealed. Eleven of 18 total Next Generation ACOs will receive a shared savings payment from CMS, while just seven organizations will repay the federal agency for shared losses. The Next Generation ACO initiative builds on the Medicare Shared Savings...

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CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline Belliveau

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in an...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline Belliveau

In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers have recently...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

by Jacqueline Belliveau

CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. The federal agency originally introduced the Medicare...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline Belliveau

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

by Jacqueline Belliveau

Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This final rule...

Skilled Nursing Facilities See $370M Medicare Reimbursement Bump

by Jacqueline Belliveau

Skilled nursing facilities are slated to receive a 1 percent increase in Medicare reimbursement in 2018, representing $370 million more dollars in healthcare payments, CMS recently announced in a final rule. While CMS finalized Medicare reimbursement...

CMS Considers Behavioral Health Alternative Payment Model

by Jacqueline Belliveau

CMS recently announced its intention to develop an alternative payment model targeting behavioral health services. The federal agency is seeking stakeholder feedback on model development in a public meeting on Sept. 8, 2017, in Baltimore. The...

Oncology Care Model Overcomes Specialty Bundled Payment Hurdles

by Jacqueline Belliveau

Episode-based payment models aim to shift financial accountability to providers for furnishing services for specific conditions or procedures. But develop specialty bundled payment models that target clinical areas, such as oncology, have proven...

AHA Calls For 25% Rule End for Fair LTCH Medicare Reimbursement

by Jacqueline Belliveau

The American Hospital Association (AHA) pressed CMS Administrator Seema Verma to reconsider proposed Medicare reimbursement provisions for long-term care hospitals (LTCHs). Specifically, the industry group called for a permanent end to the 25-Percent...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

by Jacqueline Belliveau

CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

AHA Backs Cardiac, Ortho Bundled Payments Delay Until 2018

by Jacqueline Belliveau

The American Hospital Association (AHA) recently supported a CMS proposal to further delay Medicare bundled payments for cardiac and orthopedic care episodes to Jan. 2018. The Advancing Care Coordination through Episode Payment Models postponement...

CMS Calls On Rural Hospitals to Join Alternative Payment Model

by Jacqueline Belliveau

CMS is seeking applicants to participate in a new round of the Rural Community Hospital Demonstration Program that tests a cost-based alternative payment model among small rural hospitals. Lawmakers authorized a five-year extension of the demonstration...

CMS Suggests Hospital Medicare Reimbursement Policy Changes

by Jacqueline Belliveau

CMS recently suggested changes to Medicare reimbursement policies for hospital admissions and long-term care hospital stays as well as several recommendations for other Medicare value-based purchasing programs. The proposed rule released on April...

AHA: Uncompensated Care Costs Worksheet Inaccurate, Inconsistent

by Jacqueline Belliveau

The American Hospital Association (AHA) recently called on CMS to audit and modify the hospital cost report, Worksheet S-10, before the federal agency uses the report to determine each hospital’s uncompensated care costs and supplemental...

32 Orgs to Cut Healthcare Costs, Use Under CMS Community Demo

by Jacqueline Belliveau

As part of the Accountable Health Communities Model, CMS recently selected 32 organizations to participate in two of the three program tracks that aim to lower healthcare costs and utilization by fostering clinical and community service provider...

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline Belliveau

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since 2009....

Senate Confirms Seema Verma as Next CMS Administrator

by Jacqueline Belliveau

In a 55 to 43 vote yesterday, the Senate confirmed Seema Verma as the next CMS Administrator, according to a New York Times article. Verma, the founder, president, and CEO of a health policy consulting firm, will be charged with managing...

NH Judge Rejects CMS FAQs Clarifying Medicaid DSH Payments

by Jacqueline Belliveau

A district court in New Hampshire recently prohibited CMS from enforcing two Frequently Asked Questions (FAQs) that clarified how private payer and Medicare reimbursements paid to hospitals for dually-eligible Medicaid patients would be used...

CMS Reopens Next Generation ACO Application Request Portal

by Jacqueline Belliveau

Providers interested in joining the Next Generation Accountable Care Organization (ACO) model in 2018 can now access the Request for Applications and Letter of Intent on the program’s portal, according to a recent CMS announcement. The...

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