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

Policy & Regulation News

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

November 20, 2017 - 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 bill would reverse hospital reimbursement changes to the 340B program detailed in a recent ruling on 2018 rates for the Medicare Hospital Outpatient Prospective...


Articles

Pres Trump Taps Former Pharma Exec Alex Azar as Next HHS Secretary

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President Trump recently nominated Alex M. Azar II as the next HHS Secretary, according to multiple news sources. Azar was the former president of Eli Lilly’s American division and a health official in the George W. Bush Administration....

Industry Orgs Concerned with 2018 MACRA Implementation Rule

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Industry groups, including the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA), are questioning if the new 2018 MACRA implementation rule truly promotes value-based care. In recent comments on the...

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

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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 agencies....

CMS Finalizes 2018 Hospital, Physician Medicare Reimbursement

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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 healthcare...

CMS Issues 2018 MACRA Implementation, Quality Payment Program Rule

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CMS recently issued a final 2018 MACRA implementation rule, detailing the requirements for Quality Payment Program participation in 2018. “CMS listened to feedback from the healthcare community and used it to inform policy making,”...

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

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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 chronic...

Over 1,300 Hospitals Urge CMS to Withdraw 340B Drug Payment Cuts

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Over 1,300 rural hospitals and other healthcare organizations that serve low-income communities added their voices to the growing list of stakeholders opposing proposed payment cuts to the 340B Drug Pricing program. CMS proposed in July 2017...

100+ Medical Orgs Want MACRA Implementation Flexibilities Extended

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Over 100 medical organizations recently called on House Representatives to extend MACRA implementation flexibilities that allow HHS leaders to gradually implement full program requirements. The flexibilities should go on for another three years....

Healthcare Price Growth Hits Lowest Rate in About Two Years

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Healthcare price growth in August 2017 increased by just 1.2 percent compared to the previous year, reaching the lowest growth rate in nearly two years and only three-tenths above the lowest growth rate ever recorded by Altarum Institute’s...

MedPAC Calls for MIPS Repeal, Voluntary Program Replacement

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The Affordable Care Act isn’t the only health policy facing a call for repeal and replace. The Medicare Payment Advisory Commission (MedPAC) recently urged HHS to repeal MACRA’s Merit-Based Incentive Payment System (MIPS) and replace...

Healthcare RCM Vendors ZirMed and Navicure Announce Merger

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Healthcare revenue cycle management vendors Navicure and ZirMed recently announced that the organizations signed a definitive agreement to merge. Navicure will supposedly acquire ZirMed in a deal that values at about $750 million, sources told...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

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  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 an...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

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In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers have recently...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

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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 acquired...

Scarce Public Health Funds Block Social Determinants of Health Aid

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As value-based care emphasizes preventative medicine, healthcare stakeholders aim to address social determinants of health to improve and maintain outcomes. But the lack of appropriate public health funding at federal, state, and local government...

In IRS First, Non-Profit Hospital Loses Status Under ACA Rules

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The IRS recently revoked a rural hospital’s non-profit status for failure to meet new community health needs assessment requirements under the Affordable Care Act. According to an IRS letter dated Feb. 14, 2017, the unnamed hospital lost...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

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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 Medicare...

AMGA: MIPS Exclusion Rules Inhibit Value-Based Care Under MACRA

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The American Medical Group Association (AMGA) recently opposed several proposed changes to the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. The group particularly expressed concerns...

New Medicare Fraud Audits to Ease Burden on Compliant Providers

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CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted Probe...

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