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

Medicare Reimbursement

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...

CMS Selects 200 Groups for Value-Based Care Oncology Model

by Jacqueline LaPointe

The Centers for Medicare and Medicaid Services (CMS) has announced that almost 200 physician groups and 17 health insurance companies will join the Oncology Care Model, a value-based care program starting in July for providers who furnish...

CMS Targets Medicare Payment Reform for Home Health

by Jacqueline LaPointe

By 2017, home health agencies could see a 1.0 percent, or $180 million, reduction in reimbursements due to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that mandates Medicare payment reform. In a recent fact...

CMS: Proposed Changes to Dialysis, ESRD Claims Reimbursement

by Jacqueline LaPointe

The Centers for Medicare and Medicaid Services (CMS) has recently announced proposed changes to claims reimbursement models for end-stage renal disease (ESRD) and dialysis as well as revisions to the competitive bidding program for durable...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline LaPointe

The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on...

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

by Jacqueline LaPointe

A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week,...

New DMEPOS Prices Reduce Medicare Spending, Ensure Care Access

by Jacqueline LaPointe

Riding on the success of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), CMS has announced that expanding competitive bidding prices for DMEPOS items nationwide has continued to...

Rural Hospitals May Get Senate Help with Medicare Reimbursements

by Catherine Sampson

As the healthcare industry shifts from volume to value, hospitals are expected to provide quality care as many could also potentially face lower Medicare reimbursements. At the same time, many hospitals in rural and economically distressed...

How to Reduce Wasteful Spending in the Medicare Program

by Vera Gruessner

When the Affordable Care Act was passed several years ago, it had major implications for the future of the Medicare program. According to a study from the Private Enterprise Research Center at Texas A&M University, the Affordable Care...

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service...

CMS Proposes New Healthcare Payment Models for Medicare Part B

by Vera Gruessner

New healthcare payment models are being advised by the Centers for Medicare & Medicaid Services (CMS). From alternative payment models to the Medicare Shared Savings Program and the Comprehensive Care for Joint Replacement program, the...

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