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

CMS

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

April 25, 2018 - 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 more for their healthcare, they’re demanding more. They want quality and price transparency. This is just a response to the needs of patients,”...


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CMS to Require Healthcare Price Transparency Online for Hospitals

by Jacqueline Belliveau

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 Belliveau

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 Belliveau

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 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...

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