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

CMS

CMS Accounts for Extreme Situations in CJR Bundled Payments

June 8, 2018 - 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 California wildfires. The CJR program is a partially mandatory bundled payments model run by Medicare. Under the model, Medicare provides a bundled payment for...


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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 that...

AMGA Suggests CMS Improve ACOs, Medicare Shared Savings Program

by Kate Monica

The American Medical Group Society (AMGA) recently recommended CMS focus on improving accountable care organizations (ACOs) and the Medicare Shared Savings Program (MSSP) rather than put forth a new direct provider contracting (DPC) model. AMGA...

Only 4 CMMI Alternative Payment Models Met Spending, Quality Goals

by Jacqueline LaPointe

The CMS Innovation Center is on the path to reducing healthcare costs while improving care quality through alternative payment and care delivery models, a recent Government Accountability Office (GAO) report found. But only four alternative payment...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

by Jacqueline LaPointe

Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma told...

CMS to Up Medicare Payments, Reduce Burdens for Inpatient Rehabs

by Jacqueline LaPointe

CMS is seeking to reduce the administrative burden for inpatient rehabilitation facilities on top of a proposed $75 million Medicare payments increase in the 2019 fiscal year. The federal agency released several proposed rules for post-acute...

“Just the Beginning” of Healthcare Price Transparency, Verma Says

by Jacqueline LaPointe

Requiring hospitals to post a list of their standard charges online is just the beginning of the push for increased healthcare price transparency by CMS, explained the federal agency’s Administrator Seema Verma. “As people are paying...

CMS to Require Healthcare Price Transparency Online for Hospitals

by Jacqueline LaPointe

CMS is updating its healthcare price transparency guidance to hospitals in a new proposed rule. The rule would require hospitals to make a list of their standard charges public via the Internet. Through guidelines, the federal agency already...

CMS Seeks Info on a Direct Provider Contracting Model for Medicare

by Jacqueline LaPointe

CMS is seeking comments on a potential alternative payment model that would allow primary care providers to directly bill Medicare beneficiaries through a direct provider contracting model. Currently, providers must opt out of Medicare for two...

Medicare Spending, Prices Drive Healthcare Spending Growth

by Jacqueline LaPointe

The healthcare share of the economy should reach 19.7 percent by 2026 as the average annual rate of national healthcare spending growth rate and Medicare spending accelerates, the CMS Office of the Actuary recently projected. The data, published...

Login, Submit Data Early for MIPS Reporting Success, CMS Advises

by Jacqueline LaPointe

Eligible clinicians should log into the reporting system and upload 2017 performance data as soon as possible for Merit-Based Incentive Payment System (MIPS) reporting success, CMS recently suggested in an email. Eligible clinicians reporting...

VA Leverages CMS Data Analytics to Reduce Healthcare Fraud, Waste

by Jacqueline LaPointe

The country’s two largest public-private healthcare payment systems, the VA and CMS, recently announced that they will partner to reduce healthcare fraud, waste, and abuse for veterans using data analytics tools. “The VA-HHS alliance...

Senate Confirms Former Pharma Exec Alex Azar as Next HHS Secretary

by Jacqueline LaPointe

Former Eli Lilly executive Alex Azar will now head the Department of Health and Human Services (HHS) after Senators confirmed his nomination this afternoon in a 55 to 43 vote. The Trump Administration nominated Azar back in November 2017 after...

72% of Clinicians See No Adjustment Under Value Modifier in 2018

by Jacqueline LaPointe

An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million eligible...

CMS Welcomes 58 Next Generation ACO Model Participants in 2018

by Jacqueline LaPointe

In 2018, the Next Generation ACO model will have a total of 58 participating accountable care organizations (ACOs), up from 45 organizations the previous year, CMS recently announced on the program’s Innovation Center webpage. The class...

Voluntary Bundled Payments Launch, HHS Nominee Backs Mandatory APMs

by Jacqueline LaPointe

CMS announced a new voluntary bundled payments opportunity starting in late 2018 on the same day that HHS Secretary nominee Alex Azar seemingly backed mandatory alternative payment models during a Senate Finance committee hearing. The new voluntary...

New Reporting, Shared Losses Rules for MSSP ACOs in Disaster Areas

by Jacqueline LaPointe

In a new interim final rule, CMS modified quality reporting and shared losses policies for Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) affected by recent natural disasters, such as this year’s major hurricanes...

OIG: Practice Aid, QPP Integrity Needed for MACRA Implementation

by Jacqueline LaPointe

A recent Office of the Inspector General (OIG) investigation found two major vulnerabilities with MACRA implementation. The HHS watchdog reported that CMS still needs to provide practice-specific technical assistance and implement a Quality Payment...

GAO Offers Steps to Enhance Medicaid, Medicare Fraud Strategy

by Jacqueline LaPointe

CMS demonstrates a commitment to preventing and combating Medicaid and Medicare fraud, but the federal agency’s anti-fraud efforts only partially align with the Government Accountability Office’s (GAO) Framework for Managing Fraud...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models

by Jacqueline LaPointe

CMS recently finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models slated to launch on Jan. 1, 2018 and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment initiative....

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