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

Policy & Regulation News

Would New Care Access Standards Pave the Way for VA Privatization?

February 4, 2019 - Veterans may be able to seek more private healthcare under a new proposed rule from the Department of Veterans Affairs (VA), which Secretary Robert Wilkie says is a move to improve care quality for veterans, not VA privatization. Released Jan. 30, 2019, the proposed rule would alter access standards for community care and urgent care. The standards proposed to meet the requirements of...


Some Health Services to Resume Under New Government Shutdown Deal


After 35 days of a partial government shutdown, President Trump and Congressional leaders reached a deal to reopen the government for three weeks. President Trump anticipates signing the deal as soon as Friday, Jan. 25, 2019 to restore...

Congress Wants More on CMMI Alternative Payment Model Development


The House Committee on Ways and Means is calling on CMS to boost transparency with alternative payment model development in the Center for Medicare and Medicaid Innovation (CMMI), which develops and operates alternative payment and care...

Prices Still Responsible for High US Healthcare Spending


Prices are still the primary reason healthcare spending in the US more than doubled from 2000 to 2016, revealed a new follow-up study to the landmark 2003 article titled “It’s the Prices, Stupid.” The article’s...

Hospitals Weigh in on Medicare DSH Payment Supreme Court Case


Major hospitals and medical colleges recently urged the Supreme Court to affirm a DC Circuit Court decision that HHS violated the Medicare Act when the department altered the reimbursement adjustment formula for Medicare disproportionate...

FTC’s Approach to Assessing Hospital Mergers Flawed, AHA Says


The American Hospital Association (AHA) is saying that the Federal Trade Commission’s (FTC) strategy for evaluating hospital mergers and acquisitions is “is overbroad, does not properly credit the many pro-consumer benefits of...

CMS Overhauls MSSP by Finalizing Pathways to Success for ACOs


CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), which will require accountable care organizations (ACOs) to assume downside financial risk sooner. The MSSP is the largest Medicare ACO program, boasting...

Should Medicare Accrediting Organizations Also Provide Consulting?


CMS is questioning if the financial relationships between Medicare accrediting organizations and providers are impacting the accreditors ability to accurately determine if providers are fit to participate in the largest public payer. Many...

DoJ Offers Insight into Anti-Steering, Antitrust Case with Atrium


The Department of Justice (DoJ) is shedding more light on its recent settlement with North Carolina-based Atrium Health over allegations the health system used its market power to create anti-competitive contracts with private...

HHS Unveils Plans to Increase Healthcare Competition, Choice


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...

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


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


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


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


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


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


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?


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


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


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


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...

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