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

CMS

CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost

August 2, 2018 - 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) settings, CMS finalized a rule that will require hospitals to publicize a list of their standard charges online in a machine-readable...


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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...

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)...

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...

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...

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...

“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...

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...

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...

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