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

Policy & Regulation News

Banner Health Pays $18M to Resolve Medicare Fraud Accusations

April 16, 2018 - Banner Health, one of the largest non-profit hospital systems in the country, recently agreed to pay $18 million to the federal government to resolve Medicare fraud allegations involving 12 of its hospitals in Arizona and Colorado, the Department of Justice (DoJ) reported. The Arizona-based system operates 28 acute care hospitals in six states and reports over $24.3 billion in total patient...


Judge Asks AHA to Develop Medicare Appeals Backlog Solutions


A federal judge is calling on the American Hospital Association (AHA) to recommend strategies to reduce the growing Medicare appeals backlog, a recent court order stated. According to the AHA’s website, US District Judge James Boasberg...

House Reps Create Caucus for Value-Based Reimbursement, Health IT


Four House Representatives recently announced the creation of a new bipartisan group dedicated to supporting and promoting healthcare innovation through value-based reimbursement. Representatives Mike Kelly (R-PA), Ron Kind (D-WI), Markwayne...

Judge Voids CMS Rule Altering Medicaid DSH Payment Calculations


A US District Court for Washington DC recently vacated a CMS final rule from 2017 that required third-party payments, including those from Medicare, to be used when calculating hospital-specific limits on Medicaid Disproportionate Share Hospital...

Senators Ask for Help with Quality, Healthcare Price Transparency


A bipartisan group of six senators recently penned a letter to healthcare stakeholders calling for more information on healthcare price transparency to guide and inform a new legislative initiative. Senators Bill Cassidy, MD (R-LA), Michael Bennet...

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules


A District Court in Missouri prohibited CMS from enforcing a 2017 final rule and two Frequently Asked Questions (FAQs) from 2010 that would alter the formula for calculating hospital-specific limits for  Medicaid reimbursement under the...

DoJ Memo Limiting Guidance Use to Impact Healthcare Fraud Cases


A recent Department of Justice (DoJ) memo limiting the use of regulatory guidance to pursue affirmative civil enforcement cases could alter the federal government’s approach to healthcare fraud litigation. The document from third-in-command...

Medicare Spending, Prices Drive Healthcare Spending Growth


The healthcare share of the economy should reach 19.7 percent by 2026 as the average annual rate of national healthcare spending growth rate and Medicare spending accelerates, the CMS Office of the Actuary recently projected. The data, published...

Drug Prices, Medicaid Reform Major Themes in Trump’s HHS Budget


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 plan. Alongside...

How the Bipartisan Budget Act of 2018 Impacts Claims Reimbursement


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 increasing...

CMS Extends Home Health Enrollment Suspension to Combat Fraud


In an effort to reduce Medicare fraud, CMS announced in a new rule that it will extend a moratorium on enrollment of new Medicare home health agencies in Florida, Illinois, Michigan, and Texas. The federal agency also suspended enrollment of...

VA Leverages CMS Data Analytics to Reduce Healthcare Fraud, Waste


The country’s two largest public-private healthcare payment systems, the VA and CMS, recently announced that they will partner to reduce healthcare fraud, waste, and abuse for veterans using data analytics tools. “The VA-HHS alliance...

Senate Confirms Former Pharma Exec Alex Azar as Next HHS Secretary


Former Eli Lilly executive Alex Azar will now head the Department of Health and Human Services (HHS) after Senators confirmed his nomination this afternoon in a 55 to 43 vote. The Trump Administration nominated Azar back in November 2017 after...

Voluntary Bundled Payments Launch, HHS Nominee Backs Mandatory APMs


CMS announced a new voluntary bundled payments opportunity starting in late 2018 on the same day that HHS Secretary nominee Alex Azar seemingly backed mandatory alternative payment models during a Senate Finance committee hearing. The new voluntary...

Hospital Closures Increased in States Without Medicaid Expansion


Hospitals in Medicaid expansion states were six times, or about 84 percent, less likely to face hospital closures than their peers in non-expansion states, a new Health Affairs study showed. The hospital closure rate decreased by 0.33 per 100...

New CO Law Requires Providers to Give Patients Healthcare Prices


A new healthcare price transparency law in Colorado now requires providers to give patients the costs of the most common procedures they perform. Patients should receive a list of the prices for the 15 most common services delivered at the provider...

State Reviews Beth Israel, Lahey Health Hospital Merger


The proposed hospital merger between Boston health systems Beth Israel Deaconess and Lahey Health is delayed as the state’s Health Policy Commission reviews the deal for healthcare costs, quality, and care access issues, according to local...

GAO Offers Steps to Enhance Medicaid, Medicare Fraud Strategy


CMS demonstrates a commitment to preventing and combating Medicaid and Medicare fraud, but the federal agency’s anti-fraud efforts only partially align with the Government Accountability Office’s (GAO) Framework for Managing Fraud...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models


CMS recently finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models slated to launch on Jan. 1, 2018 and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment initiative....

AMGA Advises CMS on Including MA Models as Advanced APMs by 2018


CMS can boost participation in Medicare Advantage alternative payment models in 2018 by creating a submission form that allows providers in the models to apply to participate in MACRA’s Advanced Alternative Payment Model (Advanced APM)...

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