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

Medicare Reimbursement

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says

July 17, 2018 - CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been positive. AMGA, formerly the American Medical Group Association, stated that proposed changes are a “missed opportunity to move Medicare provider...


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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 cl...Additionally, CMS may also start to reimburse clinicians for virtual care under the updated Medicare Physician Fee Schedule. The recently proposed rule would establish reimbursement for virtual check-ins and evaluations of patient-submitted...In the proposed rule, CMS also sought additional stakeholder feedback on a new hospital price transparency requirement. The federal agency is looking for more information on a rule that would require hospitals to make public a list of their...Additionally, the proposed rule would implement changes required under the Bipartisan Budget Act of 2018. Key changes from the act included only applying MIPS payment adjustments to covered professional services under the Physician Fee Sche...

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 ES...With the proposals, Verma intends to “help secure sustainable access to durable medical equipment.” Stakeholders can comment on the proposed changes to the ESRD prospective payment system and the DMEPOS Competitive Bidding Progr...

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 hea...Based on the proposed policies, CMS anticipates Medicare home health payments to increase by 2.1 percent, or $400 million, in 2018. Home health agencies should also see a net savings of $60 million in annualized costs under the proposed Pat...

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 Administrat...

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 (...In addition to these concerns, the hospital group called on CMS to reconsider payments for non-therapy ancillaries performed on high-acuity patients, finalize periodic recalibrations of the model, provide transitional support, and address h...

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 Me...CMS should pilot the activity-based reporting approach for the Promoting Interoperability program through the CMS Innovative Center, the organization added. “We recognize the difficulty in crafting a program relevant to an array of in...

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 Federati...Implementation of Medicare Severity Diagnosis-Related Groups (MS-DRGs) and sequestration will drive hospital payment reductions, Dobson | DaVanzo and Associates reported. MS-DRG implement will have the most significant impact on hospital pa...Policymakers have extended the sequestration several times under the Bipartisan Budget Act of 2013, Military Retiree COLA Restoration Bill (S. 25) of 2014, Bipartisan Budget Act of 2015, and Bipartisan Budget Act of 2018. The sequestration ...The $218.2 billion in cumulative hospital payment reduction is on top of reimbursement cuts already enacted under the Affordable Care Act, the consulting firm noted. The billions of dollars in cuts spells trouble for hospitals, explained AH...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge

by Jacqueline LaPointe

Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced alternat...

CMS Accounts for Extreme Situations in CJR Bundled Payments

by Jacqueline LaPointe

CMS updated rules for the Comprehensive Care for Joint Replacement (CJR) bundled payments model to protect participating hospitals from uncontrollable episodes costs incurred during an emergency period, like the recent Hurricanes or Califor...

Fixing Medicare, Medicaid a Top Priority for New Coalition

by Jacqueline LaPointe

Healthcare industry heavy-hitters are partnering to form a new coalition that generally aims to “improve what’s working in health care and fix what’s not,” especially in Medicare, Medicaid, and other government progr...The PAHCF also emphasizes on its website that it will focus on preserving the Medicare program for seniors. The group’s launch comes just days after the Medicare and Social Security Trustees predicted the Medicare Hospital Insurance T...

Oncologist Org Fights Medicare Reimbursement Cut to Cancer Drugs

by Jacqueline LaPointe

A group representing over 5,000 independent, community-based oncologists is suing HHS over the implementation of a two percent sequester cut to Medicare reimbursement for Part B cancer drugs. The Community Oncology Alliance (COA) is arguing...

Medicare Fund for Hospital Care to Run Out Sooner Than Expected

by Jacqueline LaPointe

The Medicare fund used to reimburse hospitals under Part A is slated to become insolvent by 2026, three years earlier than last year’s projection, a new report by the Trustees of Medicare and Social Security revealed. The sooner-than-...

Expanded Resolution Process Opens to Lower Medicare Appeals Backlog

by Jacqueline LaPointe

HHS recently announced an expanded alternative dispute resolution process that aims to reduce the growing Medicare appeals backlog. The expanded Settlement Conference Facilitation (SCF) process promises to streamline Medicare dispute resolu...Medicare appeals must also meet certain requirements to qualify for the expanded SCF process. HHS states that an appeal is eligible for the expanded SCF process if it: Medicare appeals stuck in the growing backlog must also not be included in OMHA’s Statistical Sampling Initiative and involve a beneficiary who has been found liable for the amount in dispute after the initial determination or partici...

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt

by Jacqueline LaPointe

CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is lacking. ...

CMS to Up Medicare Payments, Reduce Burdens for Inpatient Rehabs

by Jacqueline LaPointe

CMS is seeking to reduce the administrative burden for inpatient rehabilitation facilities on top of a proposed $75 million Medicare payments increase in the 2019 fiscal year. The federal agency released several proposed rules for post-acut...“CMS believes that the rehabilitation physician should have the flexibility to assess the patient and conduct the post-admission physician evaluation during one of the three face-to-face physician visits required in the first week of ...

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

by Jacqueline LaPointe

CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven P...

Rural Hospitals Get Low-Volume, Medicare-Dependent Funds Extended

by Jacqueline LaPointe

While the recent 2019 Medicare Inpatient Prospective Payment System (IPPS) rule brought major changes to healthcare price transparency and meaningful use, the rule also extended two key payment programs for small and rural hospitals. Those ...

CMS to Require Healthcare Price Transparency Online for Hospitals

by Jacqueline LaPointe

CMS is updating its healthcare price transparency guidance to hospitals in a new proposed rule. The rule would require hospitals to make a list of their standard charges public via the Internet. Through guidelines, the federal agency alread...

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the commission&rsqu...

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