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

Healthcare Policy

Healthcare Interoperability, Rule Reform Key to Value-Based Payment

December 6, 2018 - Healthcare interoperability is vital to the transition to value-based payments, the second in command at HHS recently stated at the Office of the National Coordinator for Health Information Technology (ONC) annual meeting. “Advancing Health IT is inextricably bound up with what may be the most important priority that HHS has today, which is transforming our healthcare system into...


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AHA, AAMC Sue HHS Over Site-Neutral Payment Expansion

by Jacqueline LaPointe

The American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and three healthcare organizations are suing HHS over a new site-neutral payment policy slated to take effect on January 1, 2019. The site-neutral...

HHS Unveils Plans to Increase Healthcare Competition, Choice

by Jacqueline LaPointe

Deregulation is at the top of HHS’ mind, according to a new blueprint on increasing healthcare competition and choice from several White House agencies. HHS, along with the Departments of the Treasury and Labor, the Federal Trade...

HHS to Implement 340B Drug Price Ceiling, Penalties in Jan 2019

by Jacqueline LaPointe

After several delays, HHS will implement drug price ceilings and civil monetary penalties for manufacturers under the 340B Drug Pricing Program in 2019, according to a final rule from the HHS agency, Health Resources and Services...

CMS Advances Healthcare Price Transparency With Comparison Tool

by Jacqueline LaPointe

CMS is advancing its healthcare price transparency efforts through a new online tool that allows healthcare consumers to compare Medicare payments and copayments for certain surgical procedures. The recently launched Procedure Price...

Medicare Reimbursement Rules Limit Telehealth Adoption

by Jacqueline LaPointe

Telehealth utilization among Medicare beneficiaries is on the rise, but restrictive Medicare reimbursement rules are stifling the adoption of such services, a new report shows. The CMS report on Medicare telehealth utilization between...

92% of Providers Concerned About Hospital Price Transparency Rule

by Jacqueline LaPointe

Ninety-two percent of healthcare providers are concerned about the new hospital price transparency requirement recently finalized by CMS, a new poll shows. CMS finalized the hospital price transparency requirement in the 2019 Inpatient...

Site-Neutral Payments for Hospital Clinic Visits Starting in 2019

by Jacqueline LaPointe

Hospitals will face site-neutral payments for clinic visits, but not for new clinical families of services, according to the new final 2019 Hospital Outpatient Prospective Payment System (OPPS) rule. CMS recently finalized the contentious...

CMS Clarifies Healthcare Price Transparency Rules for Hospitals

by Jacqueline LaPointe

CMS recently expanded on new healthcare price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the...

CMS Floats Rule to Save Providers $1.1B, Cut Administrative Burden

by Jacqueline LaPointe

Healthcare providers are slated to save an estimated $1.12 billion annually under a recently proposed rule from CMS that would reduce administrative burdens. The savings would stem from proposals to simplify and streamline...

Policymakers Concerned with ACO Shared Savings Under Updated MSSP

by Jacqueline LaPointe

The House Committee on Ways and Means recently voiced concerns that proposed changes to the shared savings arrangements under the Medicare Shared Savings Program (MSSP) overhaul would harm accountable care organizations (ACOs). In a...

ACOs Relax Post-Acute Care Rules to Improve Care, Reduce Costs

by Jacqueline LaPointe

Ensuring patients receive the right post-acute care at the right time is key to controlling costs in accountable care organizations (ACOs) and other population-based alternative payment models. With this in mind, Vermont’s statewide...

AHA: Create Stark Law Exception for Value-Based Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged CMS to modify the Stark Law by adding value-based reimbursement exceptions that enable providers to coordinate care and advance patient outcomes.   “To reach the full...

CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost

by Jacqueline LaPointe

CMS recently finalized a rule that will establish more comprehensive healthcare price transparency rules for hospitals. In the final rules on the Medicare prospective payment systems for the inpatient (IPPS) and long-term care (LTCH PPS)...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value

by Jacqueline LaPointe

CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make the move by implementing the...

Hospital Groups Decry Proposed Outpatient Reimbursement Cuts

by Jacqueline LaPointe

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)...

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...

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

by Jacqueline LaPointe

CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual...

ESRD Orgs May See Higher Medicare Reimbursement, Drug Payments

by Jacqueline LaPointe

A new proposal from CMS would increase Medicare reimbursement to end-stage renal disease (ESRD) facilities by $220 million and change the way the federal agency pays the facilities for new renal dialysis drugs. The proposed update to the...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH

by Jacqueline LaPointe

CMS recently approved a five-year Section 1115 demonstration allowing New Hampshire to provide Medicaid reimbursement to more behavioral health facilities for substance use disorder treatment services. The approval authorizes the Granite...

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