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

Hospital Reimbursement

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds

November 14, 2018 - Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more than one full-time equivalent (FTE). CMS is responsible for ensuring hospitals comply with federal requirements when claiming GME Medicare reimbursement. The supplemental payments offset...


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More Site-Neutral Payments to Impact Value-Based Care, Reps Says

by Jacqueline LaPointe

Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019. The Oct. 18, 2018 letter to CMS...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule

by Jacqueline LaPointe

About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows. The 200...

Medicare DSH Payment Case Makes Its Way to the Supreme Court

by Jacqueline LaPointe

The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request from HHS to revisit an appellate...

Federal Policies to Decrease Hospital Payments by $218B by 2028

by Jacqueline LaPointe

Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed. The report commissioned by the...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative...

Medical Prices Grew 28% for Hospital E&M Services Since 2012

by Jacqueline LaPointe

Medical prices for hospital evaluation and management (E&M) services rose 28 percent and allowed amounts increased 26 percent between May 2012 and 2017, the most recent FH Medical Price Index from FAIR Health revealed. The analysis of...

Fewer Hospitalizations Reduced Skilled Nursing Facility Use by 15%

by Jacqueline LaPointe

Skilled nursing facility (SNF) utilization has declined 15 percent from 2009 to 2016, a new Avalere analysis revealed. The analysis of Medicare fee-for-service claims revealed that SNF utilization dropped from 1,808 SNF days per 1,000...

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules

by Jacqueline LaPointe

A District Court in Missouri prohibited CMS from enforcing a 2017 final rule and two Frequently Asked Questions (FAQs) from 2010 that would alter the formula for calculating hospital-specific limits for  Medicaid reimbursement under...

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

by Jacqueline LaPointe

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the...

Limited Quality Benefits for Early Pay-For-Performance Adopters

by Jacqueline LaPointe

The impact of hospital pay-for-performance models, such as Medicare’s Hospital Value-Based Purchasing Program (HVBP), have been “limited and disappointing” over the past decade, researchers stated in a new BMJ study. The...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline LaPointe

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement...

AHA Opposes Medicare Reimbursement Cut for Early Hospice Care

by Jacqueline LaPointe

Congress should not pass a proposed policy to reduce Medicare reimbursement rates to hospitals discharging patients to hospice care earlier than the expected, the American Hospital Association (AHA) advised. The proposed policy builds on...

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline LaPointe

In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

by Jacqueline LaPointe

Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This...

Hospital Orgs Oppose Site-Neutral Medicare Reimbursement Cuts

by Jacqueline LaPointe

Several hospital groups recently spoke out against proposed 2018 Medicare reimbursement updates that would reduce site-neutral payments to off-campus provider-based departments from 50 percent of the outpatient rate to 25 percent. CMS...

Hospitals, ASCs, 340B Drugs Face Medicare Reimbursement Changes

by Jacqueline LaPointe

CMS recently proposed a rule that would update Medicare reimbursement rates for hospitals and ambulatory surgical centers as well as change some prescription drug rates to 340B hospitals. Hospitals would see a 2 percent Medicare...

CMS Suggests Hospital Medicare Reimbursement Policy Changes

by Jacqueline LaPointe

CMS recently suggested changes to Medicare reimbursement policies for hospital admissions and long-term care hospital stays as well as several recommendations for other Medicare value-based purchasing programs. The proposed rule released...

Does Higher Hospital Profitability Drive Up Healthcare Costs?

by Jacqueline LaPointe

The push to maximize hospital profitability across for- and non-profit organizations is driving up healthcare costs, contends a new commentary in The American Journal of Medicine. Hospitals are focusing on boosting profitability rather...

Wisconsin Hospital Questions Hospital Profitability Study

by Catherine Sampson

In a hospital profitability study, researchers from Health Affairs drew the conclusion that Gundersen Lutheran Medical Center earned a profit of $302.5 million, or $4,241 per patient, in 2013. However, Gundersen Lutheran Medical Center...

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