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

Medicare Reimbursement

Preventable Readmissions Drop Under Value-Based Care Model

by Jacqueline LaPointe

Forty-nine states and Washington DC have decreased preventable hospital readmissions under a Medicare value-based care initiative that financially penalizes hospitals with excess readmissions, reported CMS. “The Hospital...

CMS Releases DMEPOS Medicare Reimbursement Rates, Contracts

by Jacqueline LaPointe

CMS has announced new Medicare reimbursement rates for some medical equipment items and started to send contract offers to winning bidders for Medicare’s Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies...

AMGA: Tie Medicare Reimbursement to Care Coordination Metrics

by Jacqueline LaPointe

According to two comment letters to CMS, the American Medical Group Association (AMGA) has urged the federal agency to better align Medicare reimbursements and value-based incentive payments to promote enhanced care coordination. The...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

by Jacqueline LaPointe

Medicare spending would decrease by approximately $19 million a year once CMS fully implements new claims reimbursement rates for accessories associated with some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS),...

Industry Groups Call on CMS to Modify MACRA Patient Codes

by Jacqueline LaPointe

Proposed patient relationship codes that will be used under MACRA to measure appropriate resource use and determine value-based reimbursement adjustments may cause more confusion for providers and increase administrative burdens, according...

MedPac Suggests More Claims Reimbursement Cuts for Home Health

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPac) is advising CMS to deepen proposed Medicare reimbursement cuts to home health advisors to better align with actual costs and compensate for systematic overpayments. The call for more...

Can Changes to Medicare Reimbursement Appeals Reduce Backlog?

by Jacqueline LaPointe

The lengthy Medicare reimbursement appeals process poses significant revenue cycle management problems for many providers, yet new proposed fixes from HHS may not do much to solve the problem, argue several industry groups. In June, HHS...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

by Jacqueline LaPointe

The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to...

AHA: Delay Site-Neutral Rule to Address Medicare Fraud Risks

by Jacqueline LaPointe

The American Hospital Association (AHA) has asked CMS to delay the implementation of proposed site-neutral payments for another year because the payment reform rule could increase a hospital’s Medicare fraud and abuse...

AHA Critiques Medicare Reimbursement Changes for Home Health

by Jacqueline LaPointe

The American Hospital Association (AHA) is urging CMS to delay outlier provisions and streamline certain medical billing procedures proposed in a recent document aimed at home health facilities. In June, CMS released a proposed rule that...

CMS Must Inform Providers on New Medicare Reimbursement Policy

by Jacqueline LaPointe

A Vermont judge has ordered CMS to further educate providers and auditors about a recent Medicare reimbursement policy that affects skilled nursing and rehabilitation facilities, reported the Center for Medicare Advocacy. The court stated...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes

by Jacqueline LaPointe

CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to 2,022 hospitals to end the appeals...

OIG: NY Hospital Received $14.2M in Medicare Improper Payments

by Jacqueline LaPointe

A New York-based hospital overbilled Medicare by over $14.2 million between 2011 and 2012 because it did not have appropriate medical billing measures to prevent and identify improper payments, reported the Office of the Inspector General...

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?

by Jacqueline LaPointe

Many long-term acute care facilities are projected to close over the next few years as Medicare enacts a payment reform rule that will introduce site-neutral payments for certain long-term acute care services, according to a Standard &...

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts

by Jacqueline LaPointe

Over 120 general acute care hospitals have filed a lawsuit against Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell over Medicare reimbursement reductions under the two-midnight rule. The two-midnight rule...

CMS Issues Final Changes for Medicare Reimbursement Programs

by Jacqueline LaPointe

CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website. Healthcare providers in the...

CMS Updates Part A Claims Reimbursement, Auditing Policies

by Jacqueline LaPointe

To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will be limited to a six-month look-back...

End-of-Life Medicare Spending 25% Higher for Younger Seniors

by Jacqueline LaPointe

For most providers, it is not surprising that Medicare spending tends to increase in the last year of a beneficiary’s life, especially since this population is more likely to experience a serious illness and multiple chronic...

CMS Proposes to Update Medicare Reimbursement Rates for OPPS

by Jacqueline LaPointe

According to a press release, CMS has proposed changes to Medicare reimbursement rates and policies in the Hospital Outpatient and Ambulatory Surgical Centers prospective payment systems. The agency stated that the proposals account for...

HHS Proposes Changes to Medicare Reimbursement Appeals Process

by Jacqueline LaPointe

Earlier this week, the Department of Health & Human Services (HHS) released a notice of proposed rulemaking (NPRM) to modify the Medicare reimbursement appeals process in efforts to reduce the substantial backlog of unresolved...

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