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

Medicare Reimbursement

CMS Suggests Hospital Medicare Reimbursement Policy Changes

by Jacqueline LaPointe

CMS recently suggested changes to Medicare reimbursement policies for hospital admissions and long-term care hospital stays as well as several recommendations for other Medicare value-based purchasing programs. The proposed rule released...

CMS Pauses Home Health Pre-Claim Review Demonstration

by Jacqueline LaPointe

CMS recently halted the home health Pre-Claim Review demonstration in Illinois for 30 days and the program will not expand to Florida as expected in April 2017, according to the federal agency’s website. “After March 31, 2017,...

AMGA Supports 15% Limit for Medicare Advantage Encounter Data

by Jacqueline LaPointe

AMGA recently applauded CMS for further reducing the percentage of encounter data to be used to determine Medicare Advantage enrollee risk scores from 25 percent in the proposed rule to 15 percent in the final 2018 performance year...

AHA: Post-Acute Care Medicare Reimbursement Reform Needs Time

by Jacqueline LaPointe

Later this month, the Medicare Payment Advisory Commission (MedPAC) plans to vote on a draft recommendation to Congress that would accelerate the development and implementation of a unified Medicare reimbursement system for four post-acute...

Oncologist Org Opposes MedPAC Medicare Reimbursement Changes

by Jacqueline LaPointe

The Community Oncology Alliance (COA) recently expressed concerns that proposed Medicare reimbursement changes for Part B services from the Medicare Payment Advisory Commission (MedPAC) would drive cancer care to more higher-cost...

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline LaPointe

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since...

274 Orgs Calls on CMS to Add Medicare Advantage Advanced APMs

by Jacqueline LaPointe

CMS should develop financial incentives comparable to those in the Quality Payment Program’s Advanced Alternative Payment Model (APM) track for providers who assume financial risk under Medicare Advantage plans, CAPG and 273 other...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS...

CMS Awards $100M for Small, Rural Clinician MACRA Help

by Jacqueline LaPointe

ORLANDO - CMS recently selected 11 healthcare organizations to receive a total of $100 million in funding to help small and rural eligible clinicians participate in the newly-launched MACRA. Each organization received $20 million to...

One-Third of Healthcare Execs Ready for MACRA Implementation

by Jacqueline LaPointe

Only 35 percent of healthcare executives said that their organization has a MACRA implementation strategy and feels prepared for the new value-based reimbursement program, according to a recent Health Catalyst and peer60 survey. The...

AMGA: Slow Encounter Data Transition in Medicare Reimbursement

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently commended CMS for decelerating the transition to using encounter data as a means for risk-adjusting Medicare reimbursement to Medicare Advantage organizations in 2018. In an...

Patient Care Navigation Program Reduces Cancer Care Costs

by Jacqueline LaPointe

Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study...

AAFP: Primary Care Undervalued in Medicare Reimbursement

by Jacqueline LaPointe

CMS released updated physician fee schedule rates in November 2016, but the American Academy of Family Physicians (AAFP) recently contended that Medicare reimbursement rates for primary care providers are still lacking. In a letter to...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a...

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

by Jacqueline LaPointe

A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative law judge level. HHS projected the...

How the 21st Century Cures Act Impacts Medicare Reimbursement

by Jacqueline LaPointe

The 21st Century Cures Act may have been a landmark law for precision medicine, drug innovation, telemedicine, and mental health reform, but the law also contained several Medicare reimbursement policy changes set to take effect starting...

CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

by Jacqueline LaPointe

With the site-neutral Medicare reimbursement policy taking effect on Jan. 1, CMS recently released guidance on what hospital departments qualify for exemption from the rule. The federal agency clarified expanded site-neutral payment...

Net Medicare Improper Payment Recoveries Dropped 91% in 2015

by Jacqueline LaPointe

Medicare improper payment recoveries saw a significant drop in 2015, according to a recent CMS report to Congress. The Recovery Audit Contractor (RAC) program returned 91 percent less to Medicare during the 2015 fiscal year compared to...

OIG Finds Medicare Payment Problems with Two-Midnight Policy

by Jacqueline LaPointe

Hospitals may face more Medicare reimbursement audits on inpatient and outpatient claims after the Office of the Inspector General (OIG) recently found several vulnerabilities associated with the Two-Midnight policy. Using hospital and...

How Social Risk Factors Influence Value-Based Reimbursement

by Jacqueline LaPointe

Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and...

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