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

Policy & Regulation News

Leading Accountable Care Organization Group Opposes MSSP Overhaul

August 14, 2018 - The proposal to overhaul the Medicare Shared Savings Program (MSSP) would significantly harm the accountable care organization (ACO) movement, the National Association of ACOs (NAACOS) recently stated. “The administration’s proposed changes to the ACO program will halt transformation to a higher quality, more affordable, patient-centered healthcare industry, stunting...


CMS Plans to Transform MSSP to Encourage ACOs to Assume More Risk


CMS recently proposed an overhaul of Medicare’s largest accountable care organization (ACO) program, transforming it from the Medicare Shared Savings Program (MSSP) to the Pathways to Success initiative. The redesigned MSSP program...

How Can CMS Improve MACRA’s Quality Payment Program, MIPS?


While providers commend CMS for replacing the Sustainable Growth Rate with MACRA and its Quality Payment Program, many still have some reservations about the Medicare program. After completing the first Quality Payment Program performance...

AHA: Create Stark Law Exception for Value-Based Reimbursement


The American Hospital Association (AHA) recently urged CMS to modify the Stark Law by adding value-based reimbursement exceptions that enable providers to coordinate care and advance patient outcomes.   “To reach the full...

CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost


CMS recently finalized a rule that will establish more comprehensive healthcare price transparency rules for hospitals. In the final rules on the Medicare prospective payment systems for the inpatient (IPPS) and long-term care (LTCH PPS)...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value


CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make the move by implementing the...

Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals


Focusing healthcare payment reforms efforts on providers, rather than hospitals, will be key to lowering healthcare costs, CMS Administrator Seema Verma recently told stakeholders. “Over the coming months, we will create new...

CMS Proposes to Extend Site-Neutral Payments to Clinic Visits


CMS recently proposed to implement site-neutral payments for clinic visits provided at off-campus provider-based hospital departments. According to a recently proposed CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS)...

Industry Orgs Fight Anthem’s Emergency Department Payment Policy


The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the payer to retroactively deny emergency...

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes


CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual...

Hospitals to See More 340B Drug Pricing Program Oversight, Azar Says


According to HHS Secretary Alex Azar, hospitals should expect greater transparency and oversight of the 340B Drug Pricing Program to track how the program’s benefits are used to improve care for low-income and vulnerable...

CMS Aims to Protect Medicaid Payments to Providers, Not 3rd Parties


CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed regulatory change to the Medicaid...

CMS Postpones Deadlines for New Bundled Payments Model


Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced...

CMS Proposes New Grouping Model for Medicare Home Health Payments


CMS recently proposed a rule that would implement the Patient-Driven Groupings Model for Medicare home health payments by 2020. The rule would eliminate the current Medicare reimbursement system for home health agencies, which pays home...

AHA Finds Flaws with the Patient-Driven Payment Model for SNFs


CMS is in the process of redesigning Medicare reimbursement systems for post-acute care facilities, but the American Hospital Association (AHA) is taking issue with the federal agency’s latest attempt to tie skilled nursing facility...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments


In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according to a recent announcement from the...

Relaxing Scope of Practice Laws for APRNs, PAs to Boost Efficiency


Loosening scope of practice laws for advanced practice registered nurses and physician assistants and shifting spending away from physicians can boost provider productivity, driving down costs, the economic policy center The Hamilton...

AMIA Calls for Activity Reporting in Promoting Interoperability


CMS should replace process measure reporting in the new Promoting Interoperability program with activity-based reporting as in the Improvement Activities performance category of Merit-Based Incentive Reporting System (MIPS), the American...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs


CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is...

Antitrust Case Before Supreme Court May Limit Physician Referrals


An antitrust case involving credit card companies could potentially impact healthcare by allowing payers and hospital systems to limit physician referrals. Ohio v. American Express Co. is a pending case before the Supreme Court that...

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