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

Healthcare Payment Reform

Hospital Groups Decry Proposed Outpatient Reimbursement Cuts

July 30, 2018 - Hospitals groups are voicing their concerns with potential site-neutral payments and other outpatient reimbursement reductions proposed in a new rule from CMS. CMS released its proposed CY 2019 Outpatient Prospective Payment System (OPPS) rule on July 25. If finalized, the rule would reduce Medicare reimbursement to hospital outpatient departments by implementing site-neutral payments...


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Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals

by Jacqueline LaPointe

Focusing healthcare payment reforms efforts on providers, rather than hospitals, will be key to lowering healthcare costs, CMS Administrator Seema Verma recently told stakeholders. “Over the coming months, we will create new...

How Part B Drug Changes Could Impact Provider Reimbursement

by Jacqueline LaPointe

Healthcare industry experts are warning the Trump Administration that its proposal to transfer some drugs covered by Medicare Part B to Part D would have a negative impact on provider reimbursement and care quality. In the Trump...

AHA Finds Flaws with the Patient-Driven Payment Model for SNFs

by Jacqueline LaPointe

CMS is in the process of redesigning Medicare reimbursement systems for post-acute care facilities, but the American Hospital Association (AHA) is taking issue with the federal agency’s latest attempt to tie skilled nursing facility...

Value-Based Purchasing Top Health Reform Priority for Governors

by Jacqueline LaPointe

In a recent healthcare reform proposal, a bipartisan group of governors emphasized that value-based purchasing implementation will be the key to reducing healthcare costs while improving outcomes. “Coverage is important, and...

Doctors, Employers Disagree on Healthcare Payment Reform Strategy

by Jacqueline LaPointe

Healthcare providers and employers are moving to value-based reimbursement models to achieve the Triple Aim, but the stakeholders disagree on how to move healthcare payment reform efforts forward and by what means, a recent Leavitt...

Prescription Drug Rates Continue to Challenge Cancer Centers

by Jacqueline LaPointe

Prescription drug rates and the costs of new treatment modalities continued to challenge cancer centers, according to the most recent Trending Now in Cancer Care survey from the Association of Community Cancer Centers (ACCC). For the...

100+ Medical Orgs Want MACRA Implementation Flexibilities Extended

by Jacqueline LaPointe

Over 100 medical organizations recently called on House Representatives to extend MACRA implementation flexibilities that allow HHS leaders to gradually implement full program requirements. The flexibilities should go on for another three...

AHA: New Skilled Nursing Facility Payment System Needs Development

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged CMS to flesh out a proposal to implement an alternative Medicare reimbursement model for skilled nursing facilities prior to advancing the changes through official rulemaking...

Mixed APM Results Offer Lessons for Healthcare Payment Reform

by Jacqueline LaPointe

The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the...

Surveys Reveal MACRA Implementation, QPP Knowledge Lacking

by Jacqueline LaPointe

Two recent surveys indicated that healthcare provider and executive knowledge of and readiness for MACRA implementation and the Quality Payment Program are lacking despite the value-based reimbursement program launching in January 2017. A...

AHA Urges Rural, Post-Acute Care Medicare Reimbursement Reform

by Jacqueline LaPointe

In a Congressional hearing on the current status of Medicare reimbursement systems, the American Hospital Association (AHA) urged lawmakers to focus on rural hospital and post-acute care payments. MACRA extended a number of key Medicare...

Brigham and Women’s Offers Buyouts to Lower Healthcare Costs

by Jacqueline LaPointe

Boston-based Brigham and Women’s Hospital recently presented 1,600 employees with a voluntary buyout option in an effort to control the facility’s healthcare costs, a local news source reported. Hospital officials reassured...

AHA: Post-Acute Care Medicare Reimbursement Reform Needs Time

by Jacqueline LaPointe

Later this month, the Medicare Payment Advisory Commission (MedPAC) plans to vote on a draft recommendation to Congress that would accelerate the development and implementation of a unified Medicare reimbursement system for four post-acute...

NAM Advises Leaders to Prioritize Value-Based Purchasing Reform

by Jacqueline LaPointe

In a new report, the National Academy of Medicine (NAM) named value-based purchasing as one of four action priorities for healthcare stakeholders in 2017. To implement more value-based purchasing models, NAM suggested that stakeholders...

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline LaPointe

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since...

CMS Calls on Stakeholders for Pediatric APM Development Input

by Jacqueline LaPointe

CMS recently put out a request for information for a potential Medicaid and Children’s Health Insurance Program (CHIP) alternative payment model targeting pediatric care, according to an official CMS blog post. “Through the...

Coalition Offers CMMI, Alternative Payment Model Improvements

by Jacqueline LaPointe

Thirty-five healthcare industry groups recently banded together to offer the newly-approved Department of Health and Human Services (HHS) Secretary a set of guidelines for CMS Innovation Center (CMMI) and alternative payment model...

Payment Reform, Value-Based Care Top 2017 Medicaid Priorities

by Jacqueline LaPointe

Delivery system and healthcare payment reform, especially through value-based care, topped the list of 2017 Medicaid priorities, according to the annual State Medicaid Operations Survey from the National Association of Medicaid Directors...

AHA Calls for Value-Based Reimbursement Reform Under Trump

by Jacqueline LaPointe

In a recent letter to President-Elect Trump, the American Hospital Association (AHA) urged the upcoming administration to continue the value-based reimbursement transition by developing more effective alternative payment models, promoting...

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