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

Policy & Regulation News

Industry Orgs Back 2018 MACRA Implementation Flexibilities

June 27, 2017 - Healthcare industry organizations largely applauded the recently-released 2018 MACRA implementation proposal from CMS. The medical organizations commended the federal agency’s continuation of the transition year into 2018 as well as the agency’s proposed efforts to facilitate small, independent practice participation. In the 1,052-page proposed rule, CMS reiterated its commitment...


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CMS Proposes 2018 Quality Payment Program Changes

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CMS recently announced a proposed rule that would modify MACRA’s Quality Payment Program during its second performance year to ease provider burdens and continue to ramp up full participation in the program. A major proposed change would...

AHA Calls For 25% Rule End for Fair LTCH Medicare Reimbursement

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The American Hospital Association (AHA) pressed CMS Administrator Seema Verma to reconsider proposed Medicare reimbursement provisions for long-term care hospitals (LTCHs). Specifically, the industry group called for a permanent end to the 25-Percent...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

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CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

Third MI Provider Convicted in $17.1M Healthcare Fraud Case

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Healthcare fraud prevention and prosecution will continue to be a major area of focus for the Department of Justice (DoJ), Acting Assistant Attorney General Kenneth A. Blanco recently told the American Bar Association. With healthcare fraud draining...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions

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CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area of...

House Reps Address Physician Shortage in Medicare Residency Bill

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House representatives Joseph Crowley (D-NY) and Ryan Costello (R-PA) recently introduced legislation that aims to resolve physician shortage challenges by adding more Medicare-funded residency positions. A summary of the Resident Physician Shortage...

AAFP: Drop MIPS APM Pathway to Simplify MACRA Implementation

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The American Academy of Family Physicians (AAFP) recently urged CMS to simplify MACRA implementation to support primary care provider participation in the Quality Payment Program. The industry group called for several Quality Payment Program...

VA, HHS Healthcare Staffing Agreement to Up Vet Care Access

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Secretary of Veteran Affairs David J. Shulkin, MD, recently announced a new partnership between the VA and HHS that aims to boost healthcare staffing at VA facilities to improve access to care and care coordination. The collaboration agreement...

CMS Expects to Release MIPS Participation Status By May 2017

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CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement (via...

NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

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The National Association of ACOs (NAACOS) recently urged CMS to indefinitely suspend upcoming mandatory Medicare bundled payment models until the federal agency resolves financial conflicts between the episodic arrangements and accountable care...

2 APMs Take Next Step As MACRA Physician-Focused Payment Models

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Two proposed physician-focused payment models will go to the HHS Secretary for possible limited-scale testing, while one model was stopped from becoming a potential alternative payment model under MACRA, the Physician-Focused Payment Model Technical...

CMS Calls On Rural Hospitals to Join Alternative Payment Model

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CMS is seeking applicants to participate in a new round of the Rural Community Hospital Demonstration Program that tests a cost-based alternative payment model among small rural hospitals. Lawmakers authorized a five-year extension of the demonstration...

Senators Push Bill to Address Physician Shortage in Rural Areas

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Three senators recently introduced a rural healthcare bill that would extend the Conrad State 30 Program until 2021 to help alleviate the physician shortage in designated Health Professions Shortage Areas or Medically Underserved Areas. Senators...

Keep Medicare Bundled Payment Models Mandatory, Experts Say

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Switching Medicare bundled payment models that are currently mandatory in select regions to voluntary across the country would impede value-based reimbursement progress through episodic payment, industry experts warned the Trump administration...

AHA: Uncompensated Care Costs Worksheet Inaccurate, Inconsistent

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The American Hospital Association (AHA) recently called on CMS to audit and modify the hospital cost report, Worksheet S-10, before the federal agency uses the report to determine each hospital’s uncompensated care costs and supplemental...

Medicaid Expansion Linked to $5M Annual Hospital Revenue Boost

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Hospital revenue in Medicaid expansion states increased by $5 million annually per facility after states chose to extend Medicaid coverage to more individuals, a recent Robert Wood Johnson Foundation and Urban Institute report showed. The study...

Healthcare Mergers May Face New Federal Rules Under SMARTER Act

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In a 16 to 20 vote earlier this week, the House Judiciary Committee passed the Standard Merger and Acquisition Reviews Through Equal Rules Act (SMARTER Act), which could affect how federal antitrust agencies evaluate healthcare mergers and acquisitions....

AMGA Supports 15% Limit for Medicare Advantage Encounter Data

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AMGA recently applauded CMS for further reducing the percentage of encounter data to be used to determine Medicare Advantage enrollee risk scores from 25 percent in the proposed rule to 15 percent in the final 2018 performance year update. “It...

AMGA President, CEO Donald W. Fisher, PhD, Passes at 71

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AMGA President and CEO, Donald W. Fisher, PhD, CAE, passed earlier this week after battling cancer, the healthcare industry group reported. Fisher, who was 71 years old, had led the organization since 1980. “Don leaves a professional and...

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