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

Medicare Reimbursement

AHA Calls for Medicare Reimbursement Bump for Hospital Services

by Jacqueline Belliveau

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 comment...

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

by Jacqueline Belliveau

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 backlog...

How the 21st Century Cures Act Impacts Medicare Reimbursement

by Jacqueline Belliveau

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 this...

CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

by Jacqueline Belliveau

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 exemption...

Net Medicare Improper Payment Recoveries Dropped 91% in 2015

by Jacqueline Belliveau

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 2014....

OIG Finds Medicare Payment Problems with Two-Midnight Policy

by Jacqueline Belliveau

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 provider...

How Social Risk Factors Influence Value-Based Reimbursement

by Jacqueline Belliveau

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 rural...

AHA Asks CMS to Increase Site-Neutral Medicare Reimbursement

by Jacqueline Belliveau

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 industry...

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

by Jacqueline Belliveau

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 Hospitals,...

Judge Calls for Medicare Appeals Backlog Elimination by 2020

by Jacqueline Belliveau

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 two-and-a-half-year...

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

by Jacqueline Belliveau

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 Hospital...

NY Senator Challenges Rural Medicare Reimbursement Repayment

by Jacqueline Belliveau

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 payments...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

by Jacqueline Belliveau

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 2016,...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

by Jacqueline Belliveau

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 inefficiencies....

Using an Alternative Payment Model to Reduce Hospitalizations

by Jacqueline Belliveau

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 University...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

by Jacqueline Belliveau

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 payments...

Potential Challenges, Benefits of the Cardiac Bundled Payment

by Jacqueline Belliveau

Earlier this year, CMS proposed a cardiac bundled payment model that would reduce Medicare spending by $170 million on five years, but a new report in the Journal of the American Medical Association identified several potential drawbacks of the...

CMS Updates Site-Neutral Payment Reform Implementation Rule

by Jacqueline Belliveau

In a recent ruling on the outpatient prospective payment system, CMS finalized several changes to the site-neutral payment reform policy under which most provider-based hospital outpatient departments will no longer receive outpatient Medicare...

CMS Offers 66% Settlement to Reduce Medicare Appeals Backlog

by Jacqueline Belliveau

In an effort to resolve the Medicare appeals backlog, CMS recently reopened a settlement option that would allow hospitals to receive partial reimbursement for some claim denials currently stuck in the appeals process. Similar to the 2014 settlement...

Large Hospitals Fare Worse in Value-Based Reimbursement Model

by Jacqueline Belliveau

Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive Healthcare,...


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