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

Medicare Reimbursement

CMS Announces Feb 19 Deadline for Pathways to Success Applications

January 11, 2019 - Accountable care organizations (ACOs) can start their Pathways to Success applications to participate in the initiative replacing the Medicare Shared Savings Program (MSSP) in the summer of 2019. The organizations will have between Jan. 22 and Feb. 19, 2019 to apply. CMS announced the application period in a recent MLN Connects newsletter. The federal agency finalized Pathways to...


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Are Hospital Readmissions Reduction Program Results Overstated?

by Jacqueline LaPointe

CMS, researchers, and other healthcare stakeholders have touted the Hospital Readmissions Reduction Program (HRRP) touted as a success. Under the authority of the Affordable Care Act, CMS launched the HRRP in 2010 to incentivize hospitals...

Medicare, Medicaid Reimbursement $76.8B Under Hospital Costs

by Jacqueline LaPointe

The largest public payers continue to underpay hospitals, data from the most recent American Hospital Association (AHA) Annual Survey of Hospitals revealed. Medicare and Medicaid reimbursement fell $76.8 billion short of the actual costs...

Prescription Drug Spending Higher at 340B Hospitals, Study Finds

by Jacqueline LaPointe

Per-patient prescription drug spending increased by 32.4 percent at hospitals that recently enrolled in the 340B Drug Pricing Program, revealed a new Berkeley Research Group (BRG) study funded by the Pharmaceutical Research and...

Hospitals Weigh in on Medicare DSH Payment Supreme Court Case

by Jacqueline LaPointe

Major hospitals and medical colleges recently urged the Supreme Court to affirm a DC Circuit Court decision that HHS violated the Medicare Act when the department altered the reimbursement adjustment formula for Medicare disproportionate...

Specialists Fear IPI Drug Pricing Model Could Harm Patient Access

by Jacqueline LaPointe

A healthcare industry group representing more than 7,700 rheumatologists and rheumatology health professionals recently warned the Trump Administration that its proposed International Pricing Index (IPI) drug pricing model for Medicare...

HHS Overstepped Authority with 340B Reimbursement Cuts, Judge Rules

by Jacqueline LaPointe

A federal judge in Washington DC recently struck down a nearly 30 percent reduction in 340B reimbursement cuts. US District Judge Rudolph Contreras ruled that HHS Secretary Alex Azar exceeded his statutory authority by issuing a policy...

Should Medicare Accrediting Organizations Also Provide Consulting?

by Jacqueline LaPointe

CMS is questioning if the financial relationships between Medicare accrediting organizations and providers are impacting the accreditors ability to accurately determine if providers are fit to participate in the largest public payer. Many...

New Medicare Reimbursement for Lab Tests May Overpay by Billions

by Jacqueline LaPointe

A new Medicare reimbursement system for clinical laboratory tests could increase spending for the public healthcare program by over $11 billion by 2020, a new Government Accountability Office (GAO) report shows. The federal watchdog found...

AHA, AAMC Sue HHS Over Site-Neutral Payment Expansion

by Jacqueline LaPointe

The American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and three healthcare organizations are suing HHS over a new site-neutral payment policy slated to take effect on January 1, 2019. The site-neutral...

Hospital Wage Data Inaccuracies Led to Medicare Reimbursement Issues

by Jacqueline LaPointe

CMS may not be appropriately adjusting Medicare reimbursement to hospitals for local labor prices, a new HHS Office of the Inspector (OIG) report reveals. The HHS watchdog found “significant vulnerabilities” in the hospital...

Medicare Reimbursement Rules Limit Telehealth Adoption

by Jacqueline LaPointe

Telehealth utilization among Medicare beneficiaries is on the rise, but restrictive Medicare reimbursement rules are stifling the adoption of such services, a new report shows. The CMS report on Medicare telehealth utilization between...

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...

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

by Jacqueline LaPointe

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...

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...

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