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

Healthcare Policy

CMS Clarifies Healthcare Price Transparency Rules for Hospitals

October 1, 2018 - 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 definition of machine-readable, and what items and services furnished at the hospital must be included on the publicized list. In August 2018, CMS...


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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...

Hospitals to See More 340B Drug Pricing Program Oversight, Azar Says

by Jacqueline LaPointe

According to HHS Secretary Alex Azar, hospitals should expect greater transparency and oversight of the 340B Drug Pricing Program to track how the program’s benefits are used to improve care for low-income and vulnerable...

CMS Aims to Protect Medicaid Payments to Providers, Not 3rd Parties

by Jacqueline LaPointe

CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed regulatory change to the Medicaid...

CMS Postpones Deadlines for New Bundled Payments Model

by Jacqueline LaPointe

Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced...

CMS Proposes New Grouping Model for Medicare Home Health Payments

by Jacqueline LaPointe

CMS recently proposed a rule that would implement the Patient-Driven Groupings Model for Medicare home health payments by 2020. The rule would eliminate the current Medicare reimbursement system for home health agencies, which pays home...

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...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

by Jacqueline LaPointe

In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according to a recent announcement from the...

AMIA Calls for Activity Reporting in Promoting Interoperability

by Jacqueline LaPointe

CMS should replace process measure reporting in the new Promoting Interoperability program with activity-based reporting as in the Improvement Activities performance category of Merit-Based Incentive Reporting System (MIPS), the American...

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