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

Medicare Reimbursement

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

by Jacqueline LaPointe

CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven...

Rural Hospitals Get Low-Volume, Medicare-Dependent Funds Extended

by Jacqueline LaPointe

While the recent 2019 Medicare Inpatient Prospective Payment System (IPPS) rule brought major changes to healthcare price transparency and meaningful use, the rule also extended two key payment programs for small and rural hospitals. Those...

CMS to Require Healthcare Price Transparency Online for Hospitals

by Jacqueline LaPointe

CMS is updating its healthcare price transparency guidance to hospitals in a new proposed rule. The rule would require hospitals to make a list of their standard charges public via the Internet. Through guidelines, the federal agency...

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the...

Judge Asks AHA to Develop Medicare Appeals Backlog Solutions

by Jacqueline LaPointe

A federal judge is calling on the American Hospital Association (AHA) to recommend strategies to reduce the growing Medicare appeals backlog, a recent court order stated. According to the AHA’s website, US District Judge James...

Medical Billing Complexity Highest for Medicaid Fee-for-Service

by Jacqueline LaPointe

Medical billing for Medicaid fee-for-service claims proved to be the most complex across all insurers. The public payer had a claims denial rate 17.8 percentage points greater than the rate for Medicare fee-for-service claims, a new Health...

Site-Neutral Medicare Reimbursement Too Low for LTCHs, AHA Argues

by Jacqueline LaPointe

Site-neutral Medicare reimbursement for long-term care hospitals (LTCHs) will cover less than half the actual costs of care for qualifying cases, the American Hospital Association (AHA) recently told CMS. The Bipartisan Budget Act of 2013...

340B Hospitals Delivered $26B in Unreimbursed, Uncompensated Care

by Jacqueline LaPointe

Unreimbursed and uncompensated care costs were 27.4 percent higher at Disproportionate Share Hospitals (DSH) enrolled in the 340B Drug Pricing Program in 2015 compared to non-340B acute care hospitals, according to a new analysis from...

CMS Guidance to Lower Claim Denials for Inpatient Rehab Facilities

by Jacqueline LaPointe

CMS recently clarified that contracted auditors should not give inpatient rehabilitation facilities claim denials solely because the services did not meet time-based therapy requirements. The guidance, which will go into effect on March...

AHA, Hospital Groups Renew Call to End 340B Drug Payment Cuts

by Jacqueline LaPointe

After a federal judge recently ruled that CMS can enforce cuts to 340B drug payments, the American Hospital Association (AHA) and 35 state and regional hospital associations resumed their efforts to end $1.6 billion in reimbursement...

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

by Jacqueline LaPointe

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the...

Drug Prices, Medicaid Reform Major Themes in Trump’s HHS Budget

by Jacqueline LaPointe

President Trump plans to decrease HHS funding by about 21 percent compared to 2017, while focusing the federal department’s budget on prescription drug prices reductions and Medicaid reform, according to the 2019 fiscal year budget...

Medicare Wellness Visit Adoption Boosts Primary Care Revenue

by Jacqueline LaPointe

Practices that performed Medicare wellness visits on at least a quarter of their patients earned greater primary care revenue, experienced more patient assignment stability, and treated patients who were slightly healthier, a new Health...

How the Bipartisan Budget Act of 2018 Impacts Claims Reimbursement

by Jacqueline LaPointe

After facing two government shutdowns this year, Congress passed a long-term budget deal and President Trump signed it into law early on Feb. 9, 2018. While the Bipartisan Budget Act of 2018 included plans for avoiding another shutdown and...

CMS Opens Low Volume Appeals Settlement to Reduce Appeals Backlog

by Jacqueline LaPointe

In the face of a growing Medicare appeals backlog, CMS opened the first round of a low volume appeals settlement on Feb. 5 for providers with less than 500 claim denial appeals stuck in the appeals backlog at the Office of Medicare...

85% of Hospitals to See Part B Increase Despite 340B Payment Cuts

by Jacqueline LaPointe

EDITOR'S NOTE: This article has been updated with a statement from the American Hospital Association. Approximately 85 percent of hospitals will receive a net increase in their total Medicare Part B reimbursements despite recent...

Reimbursement Shortfalls, Uncompensated Care Costs Grew in 2016

by Jacqueline LaPointe

Medicaid and Medicare reimbursement in 2016 was $68.8 billion short of actual hospital costs for treating beneficiaries, according to data from the American Hospital Association (AHA). The information from the AHA’s Annual Survey of...

Judge Denies Hospital Org Attempt to Block 340B Drug Payment Cut

by Jacqueline LaPointe

A federal judge recently ruled that CMS can start to reduce 340B drug payments to hospitals by $1.6 billion starting on Jan. 1, 2018, striking a blow to several industry groups that urged the court to delay enforcement of the new rule. US...

AHA Opposes Medicare Reimbursement Cut for Early Hospice Care

by Jacqueline LaPointe

Congress should not pass a proposed policy to reduce Medicare reimbursement rates to hospitals discharging patients to hospice care earlier than the expected, the American Hospital Association (AHA) advised. The proposed policy builds on...

Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories

by Jacqueline LaPointe

From the Quality Payment Program’s launch to the Affordable Care Act debate, the healthcare finance world saw an abundance of change and uncertainty in 2017. In the face of payment reform and political debates, healthcare leaders...

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