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

CMS

Medicare Spending, Prices Drive Healthcare Spending Growth

February 15, 2018 - 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 in Health Affairs, showed that national healthcare spending will grow at an average annual rate of 5.5 percent over the next eight years. The projected...


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

by Jacqueline Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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....

AMGA Advises CMS on Including MA Models as Advanced APMs by 2018

by Jacqueline Belliveau

CMS can boost participation in Medicare Advantage alternative payment models in 2018 by creating a submission form that allows providers in the models to apply to participate in MACRA’s Advanced Alternative Payment Model (Advanced APM)...

CMS Boosts Payments to Hospitals Impacted by Two-Midnight Rule

by Jacqueline Belliveau

Sixty-seven hospitals affected by the Two-Midnight Rule will receive a boost in Medicare reimbursement on Part A discharges for the next year, a recent CMS notice explained. The notice ordered Medicare Administrative Contractors (MACs) to apply...

61% of Next Generation ACOs Earned Shared Savings in 2016

by Jacqueline Belliveau

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,...

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...

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