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


CMS Paid $22 Million in Inappropriate Medicare Claims

by Stephanie Reardon

Medicare paid $22 million for ophthalmology medicare claims in 2012 that were potentially inappropriate. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its auditon the Centers for Medicare...

CMS Adds Confusion to CME Open Payment Requirements

by Ryan Mcaskill

An update to the Open Payment database clouds requirements for reporting data to continuing medical education activities. The Sunshine Act and Open Payment database continues to be a controversial entity. Since it was launched in September, a...

Medical Billing Data Made Public to Improve Transparency

by Stephanie Reardon

New information could be useful for improving care. Transparency within the healthcare market may be easier to achieve following the release of the Physician Data File. The Commonwealth Fund has conducted an analysis of the Obama administration’s...

CMS Rule Limits Payments to Disproportionate Share Hospitals

by Stephanie Reardon

CMS final rule defines ‘uninsured,’ allowing Medicaid patients with exhausted applicable state coverage limits to be covered. Effective December 31, disproportionate share hospitals (DSH) will be subject to the Centers for Medicare...

CMS Strengthens Medicare Provider Safeguards with New Rule

by Ryan Mcaskill

A new final CMS rule will be make participation in Medicare incentive programs more difficult for bad actors. Earlier this week, covered a report from the Government Accountability Office that examined Medicare drug...

CMS Proposes Rule Changes for Accountable Care Organizations

by Ryan Mcaskill

Several potential new rules would strengthen the Medicare Shared Savings Program by altering risk/reward, enrollment and more. Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced several proposed changes that will strengthen...

CMS Addressing Medicare Drug Fraud, Waste, Abuse

by Stephanie Reardon

The Government Accountability Office compiled a report to determine practices to promote prescription drug program integrity. Because of recent law enforcement actions and the increase in focus in the media highlighting Medicare prescription...

CMS Creates Office of Enterprise Data and Analytics

by Ryan Mcaskill

Niall Brennan is CMS’ first chief data officer to improve the agency’s analytics to improve quality care at a lower cost. Big data has become more than just a buzzword across the business landscape. It is a major strategy that organizations...

OIG Releases 2014 Top Management and Performance Challenges

by Ryan Mcaskill

OIG released its annual analysis of the top current and future challenges facing the Department of Health and Human Services. Every year, the Office of Inspector General (OIG) prepares a summary of the most significant management and performance...

Quality and Financial Performance Study Finds ACO Success

by Ryan Mcaskill

A CMS study found ‘substantial improvement’ to quality and financial performance for accountable care organizations. Earlier this month, the Centers for Medicare & Medicaid Services issued quality and financial performance results that...

Palmetto Received $14K in Unallowable Medicare SERP III Costs

by Ryan Mcaskill

Palmetto Government Benefits Administrator unintentionally misfiled SERP III costs during the fiscal years 2010 and 2011. Recently, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the audit results...

CMS Awards $3.9M for Medicaid Outreach and Enrollment

by Ryan Mcaskill

New CMS funding aims to help American Indian and Alaska Native children sign up for Medicaid and CHIP services. The Centers for Medicare & Medicaid Services (CMS) announced this week that is has awarded $3.9 million for outreach and enrollment...

DSH system Could See Reduction in CMS Funding

by Ryan Mcaskill

The Affordable Care Act and congressional action could drop DSH funding by as much as $35.1 billion by 2024. Disproportionate Share Hospitals serve a significantly disproportionate number of low-income patients and receive payments from the Centers...

OIG Releases 2015 Work Plan for CMS Investigative Initiatives

by Ryan Mcaskill

The fiscal year of 2015 will include audits, evaluations and other legal investigative members of HHS agencies. The U.S. Department of Health and Human Services (HHS) Office of Inspector General has released its “Work Plan” for the fiscal...

CMS Changes Medicare Home Health Prospective Payment System

by Ryan Mcaskill

The new HH PPS for 2015 has a greater focus on efficiency, flexibility, payment accuracy and improved quality. The Centers for Medicare and Medicaid Services (CMS) announced this week that it has made changes to the Medicare home health prospective...

CMS Creating Advisory Panel for Clinical Lab Tests

by Ryan Mcaskill

An ‘expert outside advisory panel’ will help establish payment rates for new clinical diagnostic lab tests. This week, the Centers for Medicare & Medicaid Services announced that it is establishing an Advisory Panel on Clinical...

Proposed 2016 Basic Health Program Notice Issued by CMS

by Ryan Mcaskill

CMS’ 2015 proposed rules are similar to those rolled out for 2014 with several small provisions. This week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed notice establishing the methodology for determining federal...

CMS Proposes Change to Home Health Agencies CoP

by Ryan Mcaskill

On Thursday, October 9, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that would revise the current conditions of participation (CoPs) that home health agencies (HHAs) are required to meet in order to...

Industry Experts Express Concern Over CMS Open Payments Data

by Ryan Mcaskill

Last week, the Centers for Medicare & Medicaid Services (CMS) released the first set of Open Payment data. Created as part of the Sunshine Act, the initial round of information details 4.4 million payments from pharmaceutical and medical...

CMS Releases First Set of Open Payments Data

by Elizabeth Snell

The Centers for Medicare & Medicaid Services (CMS) released the first round of Open Payments data this week. The move is part of a larger effort to help consumers understand the financial relationship between the health care industry, and...


Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks