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

Medicare Reimbursement

AHA Questions Accuracy of Combined Post-Acute Care Payment System

September 20, 2017 - 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. The issues include outdated data, an overly complex regression model, and potential care access restrictions. The American Hospital Association (AHA)...


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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...

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....

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