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

Medicare Reimbursement

How CMS Improves Primary Care Payments Through Codes, APMs

by Jacqueline LaPointe

New medical billing codes for non-face-to-face encounters and alternative payment models are trying to change the way Medicare reimburses for primary care, according to researchers at the Urban Institute’s Health Policy Center. The...

Medical Billing Codes Do Not Address Full Scope of Primary Care

by Jacqueline LaPointe

Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians in about 60.3 percent of visits, a recent Journal of the American Board of Family Medicine study...

Medicare Spends $3.1B More on Hospital-Employed Physicians

by Jacqueline LaPointe

Total Medicare spending on four cardiology, orthopedic, and gastroenterology services increased by $3.1 billion between 2012 and 2015 because of the growing number of hospital-employed physicians, a recent Physicians Advocacy...

CMS Boosts Payments to Hospitals Impacted by Two-Midnight Rule

by Jacqueline LaPointe

Sixty-seven hospitals affected by the Two-Midnight Rule will receive a boost in Medicare reimbursement on Part A discharges for the next year, a recent CMS notice explained. The notice ordered Medicare Administrative Contractors (MACs) to...

House Reps Aim to Stop $1.6B Hospital Payment Cut for 340B Drugs

by Jacqueline LaPointe

A new bipartisan bill intends to block CMS from enforcing a $1.6 billion Medicare reimbursement cut under the 340B Drug Pricing Program. Representatives David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392 last week. The...

Hospital Orgs to Sue CMS Over 340B Medicare Reimbursement Cuts

by Jacqueline LaPointe

The American Hospital Association (AHA), America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) recently announced their intentions to pursue litigation against CMS to prevent Medicare reimbursement...

CMS Cancels Home Health Groupings Model, $950M Reimbursement Cut

by Jacqueline LaPointe

CMS recently scrapped the proposed Home Health Groupings Model. The model would have used clinical and patient characteristics rather than the current therapy service use thresholds to determine Medicare reimbursement for home health...

CMS Finalizes 2018 Hospital, Physician Medicare Reimbursement

by Jacqueline LaPointe

In a series of final rules released earlier this month, CMS updated and modified Medicare reimbursement rates for hospitals and physicians in 2018. The rules aim to “reflect a broader Administration-wide strategy to create a...

AMGA to Reps: Pass CHRONIC Care Act to Aid ACOs, Team-Based Care

by Jacqueline LaPointe

AMGA recently pushed House Representatives to pass the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which would particularly support accountable care organizations (ACO) implementing...

AHA Questions Accuracy of Combined Post-Acute Care Payment System

by Jacqueline LaPointe

CMS and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) should address fundamental issues with the prototype of a combined Medicare post-acute care payment system, a recent Dobson DaVanzo & Associates report...

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline LaPointe

In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment...

Does the Medicare Physician Fee Schedule Undervalue Primary Care?

by Jacqueline LaPointe

CMS continues to put the revenue of primary care providers at risk by undervaluing codes for primary care and failing to meet the misvalued code target required by law in the proposed 2018 Medicare Physician Fee Schedule update, the...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline LaPointe

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in...

AHA: New Skilled Nursing Facility Payment System Needs Development

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged CMS to flesh out a proposal to implement an alternative Medicare reimbursement model for skilled nursing facilities prior to advancing the changes through official rulemaking...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

by Jacqueline LaPointe

The CMS Advisory Panel on Hospital Outpatient Payment recently called on the federal agency to abandon proposed changes to the 340B Drug Pricing Program in 2018, which would reduce Medicare reimbursement to qualifying hospitals for drugs...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

by Jacqueline LaPointe

CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. The federal agency originally introduced the...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by Jacqueline LaPointe

A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their...

Court to Reconsider Timeline for Medicare Appeals Backlog End

by Jacqueline LaPointe

The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog...

Medicare Reimbursement Add-On to Boost Palliative Care Revenue

by Jacqueline LaPointe

A recent study in the Journal of Palliative Medicine showed that providers should be leveraging a supplemental Medicare reimbursement to enhance palliative care in the last seven days of life. CMS pays providers for furnishing routine...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

by Jacqueline LaPointe

Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This...

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