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

CMS

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...

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, RevCycleIntelligence.com 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...

Continue to site...