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

Policy & Regulation News

HHS Unveils Plans to Increase Healthcare Competition, Choice

December 5, 2018 - Deregulation is at the top of HHS’ mind, according to a new blueprint on increasing healthcare competition and choice from several White House agencies. HHS, along with the Departments of the Treasury and Labor, the Federal Trade Commission (FTC), and several offices within the White House, released the “Reforming America’s Healthcare System Through Choice and...


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HHS to Implement 340B Drug Price Ceiling, Penalties in Jan 2019

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After several delays, HHS will implement drug price ceilings and civil monetary penalties for manufacturers under the 340B Drug Pricing Program in 2019, according to a final rule from the HHS agency, Health Resources and Services...

CMS Advances Healthcare Price Transparency With Comparison Tool

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CMS is advancing its healthcare price transparency efforts through a new online tool that allows healthcare consumers to compare Medicare payments and copayments for certain surgical procedures. The recently launched Procedure Price...

92% of Providers Concerned About Hospital Price Transparency Rule

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Ninety-two percent of healthcare providers are concerned about the new hospital price transparency requirement recently finalized by CMS, a new poll shows. CMS finalized the hospital price transparency requirement in the 2019 Inpatient...

HRSA Proposes Earlier Start Date for 340B Price Transparency Rule

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HHS plans to move forward the implementation date of a long-delayed 340B price transparency rule that will stop drug manufacturers from overcharging hospitals for drugs purchased under the drug discount program. In a recent notice of...

Exploring Changes to the Quality Payment Program in 2019

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The final 2019 Medicare Physician Fee Schedule (PFS) rule contained a number of changes to evaluation and management (E/M) payment rates, site-neutral payments, and remote patient monitoring coverage. But the rule also included key MACRA...

Docs More Supportive of E/M Payment Changes, But Concerns Remain

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Healthcare industry groups remain concerned about collapsing evaluation and management (E/M) payment rates for most office visits, but the groups are generally more supportive of the final E/M payment changes. In the recently finalized...

Would the IPI Model Reduce Medicare Reimbursement for Providers?

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Physicians and hospitals would not see Medicare reimbursement drop under the proposed International Pricing Index (IPI) model, the former Senior Advisor to the Secretary for Drug Pricing Reform recently assured providers. “The model...

Site-Neutral Payments for Hospital Clinic Visits Starting in 2019

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Hospitals will face site-neutral payments for clinic visits, but not for new clinical families of services, according to the new final 2019 Hospital Outpatient Prospective Payment System (OPPS) rule. CMS recently finalized the contentious...

CMS Delays Collapsing of E/M Payment Rates Until 2021

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CMS will collapse evaluation and management (E/M) payment rates, but not until the 2021 calendar year, according to the recently released final 2019 Physician Fee Schedule (PFS) rule. After industry pushback, the federal agency will delay...

Potential Medicare Reimbursement Demo to Lower Part B Drug Prices

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In an effort to control prescription drug prices, HHS is proposing a mandatory demonstration that would test a new Medicare reimbursement model for certain physician-administered drugs payable under Part B. The proposed International...

HRSA Awards $293M to Bolster the Primary Care Workforce

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The Health Resources and Services Administration (HRSA) is looking to bolster primary care by awarding $293 million to expand the primary care workforce, HHS recently announced. The healthcare industry is facing a serious physician...

CMS to Extend Healthcare Price Transparency to Prescription Drugs

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CMS is attempting to extend healthcare price transparency to prescription drugs. According to a recently proposed rule, drug manufacturers may have to start including the list price for the medications they advertise on television. As...

Senator Urges FTC to Investigate Hospital Contracting Practices

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Senate Judiciary Committee Chairman Chuck Grassley (R-IA) recently called on the Federal Trade Commission (FTC) to investigate whether hospitals and payers in the US are deliberately engaging in anticompetitive hospital contracting...

Medicare DSH Payment Case Makes Its Way to the Supreme Court

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The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request from HHS to revisit an appellate...

CMS Clarifies Healthcare Price Transparency Rules for Hospitals

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CMS recently expanded on new healthcare price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the...

CMS Finds Errors in 2019 MIPS Payment Adjustment Calculations

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CMS recently announced that it is extending the targeted review deadline for 2017 Merit-Based Incentive Payment System (MIPS) performance feedback after the federal agency identified three errors with the scoring logic for the 2019 payment...

CMS Floats Rule to Save Providers $1.1B, Cut Administrative Burden

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Healthcare providers are slated to save an estimated $1.12 billion annually under a recently proposed rule from CMS that would reduce administrative burdens. The savings would stem from proposals to simplify and streamline...

Policymakers Concerned with ACO Shared Savings Under Updated MSSP

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The House Committee on Ways and Means recently voiced concerns that proposed changes to the shared savings arrangements under the Medicare Shared Savings Program (MSSP) overhaul would harm accountable care organizations (ACOs). In a...

Do Hospital Mergers, Acquisitions Increase Prices, Reps Ask MedPAC

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Energy and Commerce Committee leaders are calling on the Medicare Payment Advisory Commission (MedPAC) to settle the debate on whether hospital mergers and acquisitions raise prices for patients. In a recent letter to MedPAC’s...

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