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


CMS Prepares Providers for End of ICD-10 Coding Flexibilities

by Jacqueline Belliveau

Starting on October 1, CMS plans to thaw the freeze on ICD-10 implementation by adding more codes and allowing review contractors to deny claims based on level of specificity. To help healthcare providers prepare for updates to ICD-10 coding...

$17B Increase in Medicare Part D Prescription Drug Spending

by Jacqueline Belliveau

Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription drug spending...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan

by Jacqueline Belliveau

CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal agency. The...

At-Home Service Value-Based Care Model Saves Medicare $10M

by Jacqueline Belliveau

A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending. Medicare saved $10 million during the...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement

by Jacqueline Belliveau

States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid pass-through...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States

by Jacqueline Belliveau

To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its website. “CMS is continuing its efforts...

CMS Final Rule Updates Inpatient Claims Reimbursement System

by Jacqueline Belliveau

Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the Medicare Hospital...

CMS Opens Enrollment for Value-Based Primary Care Model

by Jacqueline Belliveau

CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September 15,...

CMS Issues Final Changes for Medicare Reimbursement Programs

by Jacqueline Belliveau

CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website. Healthcare providers in the Medicare...

CMS Updates Part A Claims Reimbursement, Auditing Policies

by Jacqueline Belliveau

To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will be limited to a six-month look-back period...

New Rules for Bundled Payment Models for Cardiac, Hip Care

by Jacqueline Belliveau

CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25, 2016, the...

CMS Saves $42B Through Healthcare Fraud Prevention Activities

by Jacqueline Belliveau

By using a more proactive approach to healthcare fraud protection, CMS has saved the Medicaid and Medicare programs nearly $42 billion in fiscal years 2013 and 2014. In a post on its official blog, CMS attributed the savings to an increase in...

CMS Proposes Medicare Payment Reform Rule for Primary Care

by Jacqueline Belliveau

In efforts to better support primary care physicians, CMS has announced a proposed Medicare payment reform rule that would improve payment accuracy for providers who treat chronically ill and medically complex patients. The rule would update...

CMS Proposes to Update Medicare Reimbursement Rates for OPPS

by Jacqueline Belliveau

According to a press release, CMS has proposed changes to Medicare reimbursement rates and policies in the Hospital Outpatient and Ambulatory Surgical Centers prospective payment systems. The agency stated that the proposals account for stakeholder...

House Reps Ask for FFS Waivers for Alternative Payment Models

by Jacqueline Belliveau

CMS should make it easier for fee-for-service providers to get involved in risk-based alternative payment models by reducing regulatory barriers, House representatives said in a letter this week. The seventy representatives asked CMS to waive...

CMS Selects 200 Groups for Value-Based Care Oncology Model

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) has announced that almost 200 physician groups and 17 health insurance companies will join the Oncology Care Model, a value-based care program starting in July for providers who furnish chemotherapy...

CMS Proposes Revisions to Medicaid Improper Payment Programs

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) is calling on healthcare stakeholders to comment on a proposed rule that would change how states identify improper payments stemming from Medicaid and Children’s Health Insurance Program...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

by Jacqueline Belliveau

A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week, Medicare reimbursement...

OIG: Provider-Based Status Leads to Improper Medical Billing

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) could reduce improper medical billing by eliminating provider-based designations or equalizing payments for the same services provided at different care sites, according to a recent report...

CMS Announces Pre-Claims Reimbursement Review for Home Health

by Jacqueline Belliveau

In efforts to combat Medicare fraud and provide more timely care to beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has issued a rule that requires some home health agencies to undergo a pre-claim review to qualify for full...


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