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

Medicare Spending

Seeing PCP As Main Provider Lowered Medicare Spending by 9%

June 13, 2017 - Using a primary care provider versus a specialist as the predominant provider of care and care coordination resulted in similar clinical outcomes for Medicare beneficiaries. But Medicare spending was $1,781 lower per beneficiary, a recent Journal of the American Geriatrics Society study unveiled. Medicare spending was 9 percent less when beneficiaries saw a primary care provider as their main...

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High-Cost Patients Widely Distributed Across Hospitals, Markets

by Jacqueline Belliveau

A recent American Journal of Managed Care study attempting to understand why some patients incur higher healthcare costs than others found that high-cost patients were evenly spread across providers and healthcare markets. Using a 20 percent...

32 Orgs to Cut Healthcare Costs, Use Under CMS Community Demo

by Jacqueline Belliveau

As part of the Accountable Health Communities Model, CMS recently selected 32 organizations to participate in two of the three program tracks that aim to lower healthcare costs and utilization by fostering clinical and community service provider...

Healthcare Spending Varies More by Provider Than Hospital

by Jacqueline Belliveau

A recent JAMA Internal Medicine study uncovered that healthcare spending varied more across individual providers than across hospitals. Based on Medicare data on hospitalized beneficiaries from 2011 to 2014, researchers from several Boston health...

More Primary Care Leads to Less End-of-Life Medicare Spending

by Jacqueline Belliveau

Regions with more primary care providers saw less Medicare spending on end-of-life care compared to areas with less primary care practices, a recent Annals of Family Medicine study found. Medicare spending during the last two years of life was...

Medicare Spending on Drug Coverage Tripled from 2010 to 2015

by Jacqueline Belliveau

Medicare spending on prescription drugs under the Part D catastrophic coverage program more than tripled from 2010 to 2015, increasing from $10.8 billion to $33.2 billion, the Office of the Inspector General (OIG) recently reported. The significant...

CMS Reveals Medicare-Medicaid Accountable Care Organization

by Jacqueline Belliveau

CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for dual-eligible...

Primary Care Initiative Continues to Reduce Medicare Spending

by Jacqueline Belliveau

The Comprehensive Primary Care Initiative (CPC) continued to improve quality of care and reduce Medicare spending in 2015 even though the initiative has yet to generate net healthcare savings, according to an official CMS blog post. In the initiative’s...

Higher Medicare Reimbursement Not Related to Better Quality

by Jacqueline Belliveau

According to a recent study in JAMA Surgery, Medicare reimbursement amounts for patients who were rescued from surgical complications were two to three times greater at the highest cost-of-rescue hospitals, even though patient outcomes were similar...

OIG: Add Medical Device Data to Claims Reimbursement Forms

by Jacqueline Belliveau

Claims reimbursement forms lacking appropriate fields for medical device information make it more difficult for CMS to reduce Medicare spending associated with recalled or failed devices, the Department of Health and Human Services (HHS) Inspector...

Bundled Payments Model Cuts Joint Replacement Costs by $1,166

by Jacqueline Belliveau

Hospitals participating in the Bundled Payments for Care Improvement initiative decreased Medicare spending on lower extremity joint replacement hospitalizations by $1,166 per episode compared to non-participating hospitals, reported a study...

CMS: Bundled Payments Model Will Decrease Medicare Spending

by Jacqueline Belliveau

The Bundled Payments for Care Improvement initiative has the potential to significantly reduce Medicare spending on 11 of 15 clinical episode groups that were analyzed in the program’s second annual evaluation report. In an official CMS...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

by Jacqueline Belliveau

Medicare spending would decrease by approximately $19 million a year once CMS fully implements new claims reimbursement rates for accessories associated with some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), reported...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

by Jacqueline Belliveau

The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to recent...

$17B Increase in Medicare Part D Prescription Drug Spending

by Jacqueline Belliveau

Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription drug spending...

At-Home Service Value-Based Care Model Saves Medicare $10M

by Jacqueline Belliveau

A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending. Medicare saved $10 million during the...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States

by Jacqueline Belliveau

To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its website. “CMS is continuing its efforts...

End-of-Life Medicare Spending 25% Higher for Younger Seniors

by Jacqueline Belliveau

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 conditions....

Industry Group Advises HHS to Expand Bundled Payment Models

by Jacqueline Belliveau

The Center for American Progress (CAP), a Washington think tank, has called on the federal government to expand bundled payment models in order to further reduce healthcare costs and advance value-based care. The letter to Department of...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline Belliveau

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 competitive...


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