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

Medicare Claims

Skilled Nursing Facility 3-Day Rule Behind $84M in Improper Pay

February 28, 2019 - The Office of the Inspector General (OIG) estimates CMS improperly paid $84 million for post-acute care services that did not meet the skilled nursing facility (SNF) 3-day rule in a recent two-year period. In a new report, the federal watchdog analyzed a random sample of SNF claims from more than 22,000 skilled nursing claims totaling $134.9 million from 2013 to 2015. Of the 99 random...

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Medicare Improper Payment Rate Down to 8.12%, Lowest Since 2010

by Jacqueline LaPointe

CMS recently reduced the Medicare improper payment rate as well as the improper payment rates for Medicaid and the Children’s Health Insurance Program (CHIP) for the first time in reporting history, the head of the federal agency...

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...

CMS Pauses Home Health Pre-Claim Review Demonstration

by Jacqueline LaPointe

CMS recently halted the home health Pre-Claim Review demonstration in Illinois for 30 days and the program will not expand to Florida as expected in April 2017, according to the federal agency’s website. “After March 31, 2017,...

Oncologist Org Opposes MedPAC Medicare Reimbursement Changes

by Jacqueline LaPointe

The Community Oncology Alliance (COA) recently expressed concerns that proposed Medicare reimbursement changes for Part B services from the Medicare Payment Advisory Commission (MedPAC) would drive cancer care to more higher-cost...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS...

Patient Care Navigation Program Reduces Cancer Care Costs

by Jacqueline LaPointe

Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study...

Improper Medical Billing for DMEPOS Costs Medicare Billions

by Catherine Sampson

Medicare continues to lose billions as a result of improper medical billing for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), according to the Council for Medicare Integrity. Specifically, the Medicare program...

21 States Have Overbilled the FFS Medicare Program

by Vera Gruessner

New research from the Centers for Medicare & Medicaid Services (CMS) shows that 21 states have above average rates of overbilling the Medicare program. The Supplementary Appendices for the Medicare Fee-for-Service (FFS) Improper...

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service...

EHR, Claims Systems Data Integration: Physician as Scientist

by Jacqueline DiChiara

Data, data everywhere. From smartphones to smartwatches to even smarter people, data's future within the healthcare industry was a massive trend sparking tangible widespread interest within last week’s annual HIMSS15...

Does 2015 ICD-10 Transition Mean Millions in Unpaid Claims?

by Jacqueline DiChiara

A hundred physician groups, including the American Medical Association (AMA), expressed strong trepidation regarding the potential for a dangerous accumulation of millions of dollars in unpaid Medicare claims when the ICD-10 transition...

CMS Paid $22 Million in Inappropriate Medicare Claims

by Stephanie Reardon

Medicare paid $22 million for ophthalmology medicare claims in 2012 that were potentially inappropriate. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its auditon the Centers...


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