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

CMS

Groups Question Changes to Medicare Shared Savings Program

by Stephanie Reardon

118 out of 220 participating Medicare Shared Savings Program ACOs generated savings through reduced costs, but only 58 of these ACOs managed to meet the shared savings threshold. Seventeen medical organizations which includes the American College...

AHA Reacts to Proposed Rule for Medicare Shared Savings Program

by Stephanie Reardon

CMS’s proposed changes to the Medicare Shared Savings Program would save approximately $280 million more than the median net savings in federal funds from 2016 through 2018. The Medicare Shared Savings Program (MSSP) seeks to save money...

Medicare Overpays Hospital $414,000 for Incorrect Medical Billing

by Stephanie Reardon

The Hospital did not fully comply with Medicare requirements resulting in approximately $414,000 in overpayments for incorrect medical billing. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results...

CMS Announces Year Two of Open Payments Database

by Ryan Mcaskill

March 31, 2015 is the deadline for data submission in the second year of the Open Payments database. The first year of the Centers for Medicare & Medicaid’s (CMS) Open Payments database has been rocky at best. Created by the Affordable...

California State Agency Claims $375,000 in Non-Compliant Medicaid Fees

by Stephanie Reardon

Out of 100 beneficiary-services six had not complied with federal regulations leading to over payment in Medicaid fees. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on Medicaid...

CMS Announced Possible Changes to EHR Incentive Program

by Ryan Mcaskill

CMS plans to tweak the EHR Incentive program to better align its goals with the feedback it has received from providers. Earlier this week, we reported on the upcoming February 28, deadline for healthcare providers that are eligible for the Medicare...

Looking Back on 50 Years of Medicare and Medicaid

by Stephanie Reardon

The Medicare and Medicaid system has evolved along with the healthcare industry. It was a warm day on July 30, 1965 in Washington, D.C. when President Lyndon B. Johnson signed the Social Security Amendments bill into law. This would establish...

Indiana Implements ACA Medicaid Expansion

by Stephanie Reardon

Starting February 1, 2015, eligible beneficiaries will have access to affordable high-quality healthcare coverage . Indiana has become the 28th state (including DC)  to expand its Medicaid program under the Affordable Care Act (ACA), according...

CMS Paid $35.2M in Non-compliant Claims

by Stephanie Reardon

Medicare paid approximately $35.2 million in 2010 in non-compliant claims for PMD. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on the Centers for Medicare & Medicaid...

CMS Audit Finds $17.6M Overstated for Excess Plan

by Stephanie Reardon

CMS audit discovers BCBS South Carolina overstated its allocable Excess Plan costs by approximately $17.6 million. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on Blue Cross...

New York State Agency Made $79K in Inappropriate Medicaid Claims

by Stephanie Reardon

State agency claimed Medicaid reimbursement for some home and community-based services provided by New York City providers that did not comply with Federal and State requirements. The Department of Health and Human Service (HHS) Office of Inspector...

CMS Administrator Marilyn Tavenner Steps Down

by Ryan Mcaskill

In an email to staff, Tavenner announced that February 2015 will be her last month as head of CMS. There is a major shakeup happening at the Centers for Medicare and Medicaid Services (CMS) as it has been revealed that CMS administrator Marilyn...

How can CMS Reform the Medicare Hospice Payment System?

by Stephanie Reardon

CMS must update the Medicare hospice payment system using the data gathered by this audit in order to meet the ACA requirements. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit...

CMS Restricts Ambulance Services for Improper Medicare Billing

by Stephanie Reardon

New Medicare billing regulation could limit the number of allowable ambulance transports and could reduce the revenue intake for ambulance services. Ambulance companies in New Jersey are in a bind. Past reports for improper Medicare billing for...

Preventable Readmissions Cost CMS $17 Billion

by Stephanie Reardon

The estimated annual cost of this problem for Medicare is $26 billion annually and $17 billion is considered avoidable. Preventable hospital readmissions are a big part of unnecessary medical spending. According to data from the Center for Health...

CMS Provides Clarity on $840M Quality Care and Cost Initiative

by Stephanie Reardon

CMS clarified the enrollment process for a quality care and cost initiative, and answer questions before the application process ends on February 5, 2015. In October, 2014 the Department of Health and Human Services (HHS) introduced a new initiative...

CMS Changes Medicare and Medicaid Audit Process

by Stephanie Reardon

CMS paid nearly $4 billion in improper Medicare payments. The Centers for Medicare & Medicaid Services (CMS) announced that it has expanded its contracts to four different companies – HealthDataInsights, CGI Federal, Connolly and Performant...

CMS Contractor to Refund $6.9M in Medicare Outlier Payments

by Stephanie Reardon

Noridian did not submit 10 Medicare cost reports to CMS for reconciliation and had not resolved the outlier payments from five of them. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of...

ICD-10 Acknowledgement Test Shows 87 Percent Acceptance Rate

by Ryan Mcaskill

The latest CMS ICD-10 acknowledgement test of 13,700 claims found an 87 percent acceptance rate of ICD-10 codes. It may seem as though the switch to ICD-10 is in a constant state of delay. While the current deadline to implement the inpatient...

Medicare Payments Reduced for Hospital-Acquired Conditions

by Stephanie Reardon

721 hospitals will face a one-percent reduction in Medicare payments from the federal government. Despite incentives for hospitals to reduce hospital-acquired conditions (HACs), 721 hospitals will face a one-percent reduction in Medicare payments...

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