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

Medicare Reimbursement

House Reps Aim to Stop $1.6B Hospital Payment Cut for 340B Drugs

November 20, 2017 - A new bipartisan bill intends to block CMS from enforcing a $1.6 billion Medicare reimbursement cut under the 340B Drug Pricing Program. Representatives David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392 last week. The bill would reverse hospital reimbursement changes to the 340B program detailed in a recent ruling on 2018 rates for the Medicare Hospital Outpatient Prospective...


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Hospital Orgs to Sue CMS Over 340B Medicare Reimbursement Cuts

by Jacqueline Belliveau

The American Hospital Association (AHA), America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) recently announced their intentions to pursue litigation against CMS to prevent Medicare reimbursement reductions...

CMS Cancels Home Health Groupings Model, $950M Reimbursement Cut

by Jacqueline Belliveau

CMS recently scrapped the proposed Home Health Groupings Model. The model would have used clinical and patient characteristics rather than the current therapy service use thresholds to determine Medicare reimbursement for home health agencies....

CMS Finalizes 2018 Hospital, Physician Medicare Reimbursement

by Jacqueline Belliveau

In a series of final rules released earlier this month, CMS updated and modified Medicare reimbursement rates for hospitals and physicians in 2018. The rules aim to “reflect a broader Administration-wide strategy to create a healthcare...

AMGA to Reps: Pass CHRONIC Care Act to Aid ACOs, Team-Based Care

by Jacqueline Belliveau

AMGA recently pushed House Representatives to pass the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which would particularly support accountable care organizations (ACO) implementing chronic...

AHA Questions Accuracy of Combined Post-Acute Care Payment System

by Jacqueline Belliveau

CMS and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) should address fundamental issues with the prototype of a combined Medicare post-acute care payment system, a recent Dobson DaVanzo & Associates report stated....

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline Belliveau

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 for the...

Does the Medicare Physician Fee Schedule Undervalue Primary Care?

by Jacqueline Belliveau

CMS continues to put the revenue of primary care providers at risk by undervaluing codes for primary care and failing to meet the misvalued code target required by law in the proposed 2018 Medicare Physician Fee Schedule update, the American...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline Belliveau

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in an...

AHA: New Skilled Nursing Facility Payment System Needs Development

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged CMS to flesh out a proposal to implement an alternative Medicare reimbursement model for skilled nursing facilities prior to advancing the changes through official rulemaking processes. CMS...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

by Jacqueline Belliveau

The CMS Advisory Panel on Hospital Outpatient Payment recently called on the federal agency to abandon proposed changes to the 340B Drug Pricing Program in 2018, which would reduce Medicare reimbursement to qualifying hospitals for drugs acquired...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

by Jacqueline Belliveau

CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. The federal agency originally introduced the Medicare...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by Jacqueline Belliveau

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...

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...

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