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

Medicare Reimbursement

Efficient Hospitals Face Negative Medicare Margins, MedPAC Finds

March 18, 2019 - Medicare reimbursement rates rarely cover the actual costs of providing hospital care. But now negative Medicare margins are impacting the most efficient hospitals out there, according to a new report from the Medicare Payment Advisory Commission (MedPAC). In the commission’s annual March report to Congress, MedPAC reported that the select group of hospitals providing relatively...


More Articles

Medicare Public Option Would Cut Hospital Reimbursement by $774B

by Jacqueline LaPointe

A new report shows implementing a Medicare public option would decrease hospital reimbursement by $774 billion over a ten-year period, representing a ten percent reduction in payments. The report, prepared by KNG Health Consulting on...

White House Proposes $845B in Medicare Spending Cuts

by Jacqueline LaPointe

President Trump’s budget proposal for the 2020 fiscal year is requesting a tightening of the purse strings for HHS, including $845 billion in Medicare spending cuts over the next decade. The budget proposal released March 11 by the...

Medicare Reimbursement Changes Coming for Kidney Care, Dialysis

by Jacqueline LaPointe

HHS is reexamining Medicare reimbursement structures in kidney care that encourage more dialysis center treatment, rather than home-based care or even transplants. HHS Secretary Alex Azar made the announcement at the sixth annual Kidney...

Skilled Nursing Facility 3-Day Rule Behind $84M in Improper Pay

by Jacqueline LaPointe

The Office of the Inspector General (OIG) estimates CMS improperly paid $84 million for post-acute care services that did not meet the skilled nursing facility (SNF) 3-day rule in a recent two-year period. In a new report, the federal...

More Outpatient Site-Neutral Payments to Cut Costs, Coalition Says

by Jacqueline LaPointe

Extending and establishing site-neutral payments for outpatient services is the key to lowering healthcare costs, a coalition of patient advocates, providers, payers, and employers recently told top policymakers. “Site neutral...

Aligning the Medicare Physician Fee Schedule with Value

by Jacqueline LaPointe

The healthcare industry is committed to moving to value-based reimbursement. However, like many transformations in healthcare, the shift away from fee-for-service has been a long journey. CMS and other major payers cannot transition...

HHS Releases Alternative Payment Model for Ambulance Providers

by Jacqueline LaPointe

HHS and the CMS Innovation Center (CMMI) recently announced a new alternative payment model for ambulance providers that aims to improve Medicare emergency transport services. The five-year Emergency Triage, Treat, and Transport (ET3)...

More Hospitals Sue HHS Over Outpatient Site-Neutral Payments

by Jacqueline LaPointe

Thirty-eight hospitals filed a lawsuit against HHS over a $380 million reduction in Medicare reimbursement to hospitals under a new outpatient site-neutral payment policy. The lawsuit alleges that HHS Secretary Alex Azar overstepped his...

CMS Announces Feb 19 Deadline for Pathways to Success Applications

by Jacqueline LaPointe

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...

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...

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...