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

Medicare Reimbursement

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds

November 14, 2018 - Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more than one full-time equivalent (FTE). CMS is responsible for ensuring hospitals comply with federal requirements when claiming GME Medicare reimbursement. The supplemental payments offset...


More Articles

Court Orders HHS to Eliminate Medicare Appeals Backlog by 2022

by Jacqueline LaPointe

HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order. Judge James E. Boasberg of the US District Court for the District of...

5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment

by Jacqueline LaPointe

Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results...

CMS Commits to Modernizing Medicare Billing for Office Visits

by Jacqueline LaPointe

Finalizing the consolidation of Medicare billing codes for evaluation and management (E/M) outpatient and office visits is the first step for CMS as the federal agency modernizes the payment structure for office visits, CMS Administrator...

Docs More Supportive of E/M Payment Changes, But Concerns Remain

by Jacqueline LaPointe

Healthcare industry groups remain concerned about collapsing evaluation and management (E/M) payment rates for most office visits, but the groups are generally more supportive of the final E/M payment changes. In the recently finalized...

Would the IPI Model Reduce Medicare Reimbursement for Providers?

by Jacqueline LaPointe

Physicians and hospitals would not see Medicare reimbursement drop under the proposed International Pricing Index (IPI) model, the former Senior Advisor to the Secretary for Drug Pricing Reform recently assured providers. “The model...

AHA, AAMC to Challenge Site-Neutral Payment Policy in Court

by Jacqueline LaPointe

The American Hospital Association (AHA), along with the Association of American Medical Colleges (AAMC) and their member hospitals, plan to bring a lawsuit against CMS for recently released site-neutral payment rules for hospital clinic...

Site-Neutral Payments for Hospital Clinic Visits Starting in 2019

by Jacqueline LaPointe

Hospitals will face site-neutral payments for clinic visits, but not for new clinical families of services, according to the new final 2019 Hospital Outpatient Prospective Payment System (OPPS) rule. CMS recently finalized the contentious...

CMS Delays Collapsing of E/M Payment Rates Until 2021

by Jacqueline LaPointe

CMS will collapse evaluation and management (E/M) payment rates, but not until the 2021 calendar year, according to the recently released final 2019 Physician Fee Schedule (PFS) rule. After industry pushback, the federal agency will delay...

CMS Shifting Home Health to Value-Based Payments Under New Model

by Jacqueline LaPointe

CMS recently finalized a new value-based payment system for home health agencies that would move Medicare reimbursement away from the volume of therapy delivered. Medicare will start to reimburse home health agencies under the...

Potential Medicare Reimbursement Demo to Lower Part B Drug Prices

by Jacqueline LaPointe

In an effort to control prescription drug prices, HHS is proposing a mandatory demonstration that would test a new Medicare reimbursement model for certain physician-administered drugs payable under Part B. The proposed International...

More Site-Neutral Payments to Impact Value-Based Care, Reps Says

by Jacqueline LaPointe

Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019. The Oct. 18, 2018 letter to CMS...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule

by Jacqueline LaPointe

About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows. The 200...

Medicare DSH Payment Case Makes Its Way to the Supreme Court

by Jacqueline LaPointe

The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request from HHS to revisit an appellate...

Auditors Recouped $214M in Medicare Improper Payments in 2016

by Jacqueline LaPointe

Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned...

AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments

by Jacqueline LaPointe

CMS should withdraw new proposals to expand site-neutral payments to hospital outpatient clinic visits and services from expanded clinical families delivered at off-campus provider-based departments (PBDs), the American Hospital...

CMS Floats Rule to Save Providers $1.1B, Cut Administrative Burden

by Jacqueline LaPointe

Healthcare providers are slated to save an estimated $1.12 billion annually under a recently proposed rule from CMS that would reduce administrative burdens. The savings would stem from proposals to simplify and streamline...

Providers Oppose Collapsing Medicare Reimbursement for E/M Visits

by Jacqueline LaPointe

Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5 visits. In a recently proposed rule for...

AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment

by Jacqueline LaPointe

The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services. The 2019 CPT code set...

Paying LTCHs Like Skilled Nursing Would Save $4.6B, Analysis Finds

by Jacqueline LaPointe

Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper found. Medicare savings would stem from the...

X

Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...