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

Medicare Spending

CMS: Bundled Payments Model Will Decrease Medicare Spending

by Jacqueline LaPointe

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...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

by Jacqueline LaPointe

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),...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

by Jacqueline LaPointe

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...

$17B Increase in Medicare Part D Prescription Drug Spending

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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...

Industry Group Advises HHS to Expand Bundled Payment Models

by Jacqueline LaPointe

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...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline LaPointe

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...

OIG: Provider-Based Status Leads to Improper Medical Billing

by Jacqueline LaPointe

The Centers for Medicare and Medicaid Services (CMS) could reduce improper medical billing by eliminating provider-based designations or equalizing payments for the same services provided at different care sites, according to a recent...

New DMEPOS Prices Reduce Medicare Spending, Ensure Care Access

by Jacqueline LaPointe

Riding on the success of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), CMS has announced that expanding competitive bidding prices for DMEPOS items nationwide has continued to...

CPC Initiative Improves Care Delivery But Not Medicare Spending

by Catherine Sampson

Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers from The New England Journal of...

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments

by Catherine Sampson

On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that addresses the problematic two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule...

States Could Build Upon the Affordable Care Act to Cut Costs

by Vera Gruessner

The Affordable Care Act has had two main goals for the healthcare system: Increase health insurance coverage for Americans and lower healthcare spending around the country. At this point in time, the Affordable Care Act has brought health...

How to Reduce Wasteful Spending in the Medicare Program

by Vera Gruessner

When the Affordable Care Act was passed several years ago, it had major implications for the future of the Medicare program. According to a study from the Private Enterprise Research Center at Texas A&M University, the Affordable Care...

CMS May Save $343 Million through Surgical Bundled Payments

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Care for Joint Replacement Model a little more than a week ago. This program is meant to issue bundled payments for a particular episode of care - in this...

Affordable Care Act Increases Spending For Newly Insured

by Catherine Sampson

As the Affordable Care Act (ACA) brings more patients into the healthcare system, spending is on the rise, especially on chronic diseases, such as diabetes, heart disease and depression. Blue Cross Blue Shield (BCBS) backs this point in a...

Medicare Spending Increases Slightly under Affordable Care Act

by Jacqueline LaPointe

In 2014, Medicare spending for personal healthcare expenditures only increased by 2.4 percent per person and decreased by 3.6 percent for Medicaid, a recent report by the Department of Health and Human Services (HHS) stated. In...

House Budget Proposes ACA Repeal, Reduced Medicare Spending

by Jacqueline LaPointe

The House of Representatives proposed budget plan for 2017 from the House Budget Committee aims to repeal the Affordable Care Act (ACA), reduce Medicare spending, and give states more control with health programs. “With respect to...

CMS Awards Equipment Contracts to Reduce Medicare Spending

by Jacqueline LaPointe

CMS continues to reduce Medicare spending by awarding contracts to successful bidders for Medicare’s Round 2 and national mail-order recompetes and releasing new single payment amounts for the Durable Medical Equipment, Prosthetics,...

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