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

Medicare Reimbursement

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...

AHA Asks CMS to Increase Site-Neutral Medicare Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) recently advised CMS to increase Medicare reimbursement rates to off-campus provider-based outpatient departments that will be paid under site-neutral payment rules starting on Jan. 1, 2017. The...

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

by Jacqueline LaPointe

Medicaid and Medicare reimbursement in 2015 was under actual hospital costs for treating beneficiaries by $57.8 billion, the American Hospital Association (AHA) recently reported. According to data from the AHA’s Annual Survey of US...

Judge Calls for Medicare Appeals Backlog Elimination by 2020

by Jacqueline LaPointe

The Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog at the administrative law judge review level by Dec. 31, 2020, a federal judge recently decided. The most recent decision ends a...

AHA, FAH: ACA Repeal Could Cost Hospital Revenue Cycle Billions

by Jacqueline LaPointe

Providers could face billions in hospital revenue cycle losses if the Affordable Care Act is repealed without replacement legislation that preserves health coverage increases and rolls back claims reimbursement cuts, stated the American...

NY Senator Challenges Rural Medicare Reimbursement Repayment

by Jacqueline LaPointe

New York Senator Charles Schumer (D-NY) recently spoke out against a CMS plan to recoup supplemental Medicare reimbursement to rural hospitals that could cause hospitals in New York alone to repay the federal agency $15 to $20 million for...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

by Jacqueline LaPointe

The American Hospital Association (AHA) recently called on Congress to pass several healthcare payment reform bills, such as the Helping Hospitals Improve Patient Care Act and the Sustaining Healthcare Integrity and Fair Treatment Act of...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

by Jacqueline LaPointe

The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention...

Using an Alternative Payment Model to Reduce Hospitalizations

by Jacqueline LaPointe

Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

by Jacqueline LaPointe

In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims accounted for $10.45 billion in improper...

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