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

Medicare Reimbursement

Post-Acute Care Payment Reform Threatens Rural Hospitals

August 17, 2017 - A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their post-acute care revenue, a recent NC Rural Health Research Program brief stated. “If the number of rural providers of PAC [post-acute care] and hospice...


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Court to Reconsider Timeline for Medicare Appeals Backlog End

by Jacqueline Belliveau

The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog despite the...

Medicare Reimbursement Add-On to Boost Palliative Care Revenue

by Jacqueline Belliveau

A recent study in the Journal of Palliative Medicine showed that providers should be leveraging a supplemental Medicare reimbursement to enhance palliative care in the last seven days of life. CMS pays providers for furnishing routine home care...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

by Jacqueline Belliveau

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 final rule...

Skilled Nursing Facilities See $370M Medicare Reimbursement Bump

by Jacqueline Belliveau

Skilled nursing facilities are slated to receive a 1 percent increase in Medicare reimbursement in 2018, representing $370 million more dollars in healthcare payments, CMS recently announced in a final rule. While CMS finalized Medicare reimbursement...

Hospital Orgs Oppose Site-Neutral Medicare Reimbursement Cuts

by Jacqueline Belliveau

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 recently...

Hospitals, ASCs, 340B Drugs Face Medicare Reimbursement Changes

by Jacqueline Belliveau

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 reimbursement...

GAO: Hospital Value-Based Purchasing Model Rewards Low Quality

by Jacqueline Belliveau

A new Government Accountability Office (GAO) report found that CMS gave financial bonuses to hospitals participating in the Hospital Value-Based Purchasing Program despite the facilities earning composite quality scores below the median. Using...

AHA Calls For 25% Rule End for Fair LTCH Medicare Reimbursement

by Jacqueline Belliveau

The American Hospital Association (AHA) pressed CMS Administrator Seema Verma to reconsider proposed Medicare reimbursement provisions for long-term care hospitals (LTCHs). Specifically, the industry group called for a permanent end to the 25-Percent...

2016 Medicaid, Medicare Improper Payments Over Regulatory Cap

by Jacqueline Belliveau

A recent Office of the Inspector General (OIG) report revealed that the rates of Medicaid and Medicare improper payments in 2016 exceeded the legislative threshold of less than 10 percent. The improper payment rate for Medicare fee-for-service...

AHA Urges Rural, Post-Acute Care Medicare Reimbursement Reform

by Jacqueline Belliveau

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 reimbursement...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions

by Jacqueline Belliveau

CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area of...

Medicare Appeals Backlog Delays Decision Process By 4.5 Years

by Jacqueline Belliveau

Hospitals waited an average of 1,663.3 days, or a little over 4.5 years, to conclude the Medicare reimbursement audit and appeals process because of the extensive Medicare appeals backlog, a recent Journal of Hospital Medicine study uncovered....

Value-Based Penalties Target Hospitals With High Risk Patients

by Jacqueline Belliveau

Hospitals that serve greater volumes of African-American patients and those with more severe conditions are more likely to receive a value-based penalty under the Medicare Hospital Readmissions Reduction Program (HRRP), a new JAMA Cardiology...

AMGA: Align Medicare Reimbursement, Measures for High-Value Care

by Jacqueline Belliveau

AMGA recently called on CMS to align quality measures with spending performance as well as Medicare reimbursement policies across Medicare Advantage, fee-for-service models, and accountable care organizations (ACOs). In two letters to CMS Acting...

CMS Suggests Hospital Medicare Reimbursement Policy Changes

by Jacqueline Belliveau

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 on April...

CMS Pauses Home Health Pre-Claim Review Demonstration

by Jacqueline Belliveau

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, and...

AMGA Supports 15% Limit for Medicare Advantage Encounter Data

by Jacqueline Belliveau

AMGA recently applauded CMS for further reducing the percentage of encounter data to be used to determine Medicare Advantage enrollee risk scores from 25 percent in the proposed rule to 15 percent in the final 2018 performance year update. “It...

AHA: Post-Acute Care Medicare Reimbursement Reform Needs Time

by Jacqueline Belliveau

Later this month, the Medicare Payment Advisory Commission (MedPAC) plans to vote on a draft recommendation to Congress that would accelerate the development and implementation of a unified Medicare reimbursement system for four post-acute care...

Oncologist Org Opposes MedPAC Medicare Reimbursement Changes

by Jacqueline Belliveau

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 settings. “MedPAC...

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