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

Medicare and Medicaid Services

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts

August 3, 2016 - Over 120 general acute care hospitals have filed a lawsuit against Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell over Medicare reimbursement reductions under the two-midnight rule. The two-midnight rule stipulates that Medicare beneficiaries who are expected to stay in the hospital across two midnights should be admitted as inpatients, and that the provider...

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HHS Proposes Changes to Medicare Reimbursement Appeals Process

by Jacqueline Belliveau

Earlier this week, the Department of Health & Human Services (HHS) released a notice of proposed rulemaking (NPRM) to modify the Medicare reimbursement appeals process in efforts to reduce the substantial backlog of unresolved appeals. “The...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline Belliveau

The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on competitive...

Congress Asks CMS to Scrap Prior Authorization for Home Health

by Catherine Sampson

A CMS proposal to require a prior authorization screening for every home health service would be an administrative nightmare and may produce barriers to care for needy patients, a group of 116 lawmakers said in a letter to CMS this week. "This...

GAO: Weak Medicare, Medicaid Provider Screening Allows Fraud

by Catherine Sampson

The Centers for Medicare & Medicaid Services’ (CMS) provider enrollment screening process is vulnerable to fraud because many ineligible providers are still being entered into the Provider Enrollment, Chain and Ownership System (PECOS),...

CMS Payment Reforms Mean Big Bucks for Medicare, Medicaid

by Catherine Sampson

Over the past month, CMS has announced finalized and proposed rules that would significantly impact payment policies in 2017 for managed care in Medicaid and the Children’s Health Insurance Program (CHIP) as well as Medicare hospice benefits,...

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments

by Catherine Sampson

On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that addresses the problematic two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule would...

BMC Pays $1.1M to Resolve Medical Billing Fraud Allegations

by Catherine Sampson

Medical billing fraud, waste and abuse in Medicare and Medicaid appears to be an incurable disease. Although funds for these services are supposed to be for vulnerable populations with health needs, they are frequently used for other reasons....

CMS Extends Deadline for Bundled Payment Models Participation

by Vera Gruessner

The federal government especially the Centers for Medicare & Medicaid Services (CMS) have long focused on reducing healthcare spending and implementing alternative payment models such as pay-for-performance initiatives. Bundled payment models,...

CMS May Save $343 Million through Surgical Bundled Payments

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Care for Joint Replacement Model a little more than a week ago. This program is meant to issue bundled payments for a particular episode of care - in this case,...

How Value-Based Care Payment Improves Patient Outcomes

by Vera Gruessner

Last month, the Centers for Medicare and Medicaid Services (CMS) released a new value-based care payment system for Medicare Part B drug prescribing protocols of physicians. Medicare Part B is a program in which decisions are reimbursed for prescribing...

Value-Based Care Final Rule to Implement MACRA Sent to OMB

by Jacqueline Belliveau

The final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) — and its provisions for value-based care and reimbursement — is now in the hands of the Office of Management and Budget (OMB) according...

Health Insurance Exchange Tips for Taxpayers Before April 15

by Vera Gruessner

With the deadline for filing this year’s taxes just around the corner, it is useful for insurance consumers to refresh the requirements of tax filing when covered through the health insurance exchange. The majority of people who purchase...

CMS Awards Equipment Contracts to Reduce Medicare Spending

by Jacqueline Belliveau

CMS continues to reduce Medicare spending by awarding contracts to successful bidders for Medicare’s Round 2 and national mail-order recompetes and releasing new single payment amounts for the Durable Medical Equipment, Prosthetics, Orthotics,...

Value-Based Reimbursement May Not Bring Benefits for SNF Care

by Jacqueline Belliveau

CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013.  The data raises questions about the effect of...

Federal Agencies Advance Alternative Payment Models in Medicine

by Vera Gruessner

In recent years, the federal government has positioned the healthcare industry to adopt new reimbursement tactics aimed at strengthening pay-for-performance initiatives. These regulations consist of alternative payment models such as bundled...

Providers Squeezed to Integrate Care Management Solutions

by Vera Gruessner

At this year’s HIMSS conference and exhibition, Chilmark Research released the 2016 Care Management Market Trends report, which outlines how the market is leaning on healthcare providers to create care management solutions. The report also...

Patient Accounting Systems Disrupt Revenue Cycle Management

by Jacqueline DiChiara

Most hospitals experienced a noteworthy revenue cycle management performance disruption following recent conversion of their patient accounting systems (PAS), according to a new Crowe Horwath benchmark report.   Technological innovations...

CMS Proposes Changes to ACO Medicare Shared Savings Program

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to improve performance incentives for accountable care organizations (ACOs) under the Medicare Shared Savings Program. This proposal builds upon the growth of...

Affordable Care Act Creates Tax-Funded Expenditure Majority

by Jacqueline DiChiara

Over 64 percent of healthcare spending is tied to tax-funded expenditures, according to new data from the American Journal of Public Health. This reported number apparently contradicts commonplace perceptions about the cost of healthcare. Researchers...


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