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

Medicare Reimbursement

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...

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...

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