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

Policy & Regulation News

New Medicare Fraud Audits to Ease Burden on Compliant Providers

August 21, 2017 - 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 and Educate method replaces the medical review strategy that included broad medical billing investigations and provider education. Starting in 2014,...


Court to Reconsider Timeline for Medicare Appeals Backlog End


The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog despite the...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models


UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the Comprehensive...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B


Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This final rule...

CMS Details $43B Drop in Medicaid Uncompensated Care Support


In a recently proposed rule, CMS outlined a methodology for reducing Medicaid support for hospitals incurring significant uncompensated care costs starting in 2018. The rule would implement reductions of $1 billion per year in Medicaid Disproportionate...

CMS Considers Behavioral Health Alternative Payment Model


CMS recently announced its intention to develop an alternative payment model targeting behavioral health services. The federal agency is seeking stakeholder feedback on model development in a public meeting on Sept. 8, 2017, in Baltimore. The...

AMA Backs CMS Diabetes, Legacy Value-Based Purchasing Changes


The American Medical Association (AMA) recently commended CMS for several recommendations outlined in the recently proposed 2018 Physician Fee Schedule rule. The industry group particularly welcomed a potential Medicare Diabetes Prevention Program...

Hospital Orgs Oppose Site-Neutral Medicare Reimbursement Cuts


Several hospital groups recently spoke out against proposed 2018 Medicare reimbursement updates that would reduce site-neutral payments to off-campus provider-based departments from 50 percent of the outpatient rate to 25 percent. CMS recently...

Hospitals, ASCs, 340B Drugs Face Medicare Reimbursement Changes


CMS recently proposed a rule that would update Medicare reimbursement rates for hospitals and ambulatory surgical centers as well as change some prescription drug rates to 340B hospitals. Hospitals would see a 2 percent Medicare reimbursement...

Healthcare Costs Up 47.2% Despite Little Change in Utilization


Healthcare costs increased 47.2 percent from $246 per individual per month in 1996 and 1997 to $362 per individual per month in 2011 and 2012 despite healthcare utilization and the number of individuals seeking care remaining relatively unchanged...

Industry Orgs Back 2018 MACRA Implementation Flexibilities


Healthcare industry organizations largely applauded the recently-released 2018 MACRA implementation proposal from CMS. The medical organizations commended the federal agency’s continuation of the transition year into 2018 as well as the...

CMS Proposes 2018 Quality Payment Program Changes


CMS recently announced a proposed rule that would modify MACRA’s Quality Payment Program during its second performance year to ease provider burdens and continue to ramp up full participation in the program. A major proposed change would...

AHA Calls For 25% Rule End for Fair LTCH Medicare Reimbursement


The American Hospital Association (AHA) pressed CMS Administrator Seema Verma to reconsider proposed Medicare reimbursement provisions for long-term care hospitals (LTCHs). Specifically, the industry group called for a permanent end to the 25-Percent...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018


CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

Third MI Provider Convicted in $17.1M Healthcare Fraud Case


Healthcare fraud prevention and prosecution will continue to be a major area of focus for the Department of Justice (DoJ), Acting Assistant Attorney General Kenneth A. Blanco recently told the American Bar Association. With healthcare fraud draining...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions


CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area of...

House Reps Address Physician Shortage in Medicare Residency Bill


House representatives Joseph Crowley (D-NY) and Ryan Costello (R-PA) recently introduced legislation that aims to resolve physician shortage challenges by adding more Medicare-funded residency positions. A summary of the Resident Physician Shortage...

AAFP: Drop MIPS APM Pathway to Simplify MACRA Implementation


The American Academy of Family Physicians (AAFP) recently urged CMS to simplify MACRA implementation to support primary care provider participation in the Quality Payment Program. The industry group called for several Quality Payment Program...

VA, HHS Healthcare Staffing Agreement to Up Vet Care Access


Secretary of Veteran Affairs David J. Shulkin, MD, recently announced a new partnership between the VA and HHS that aims to boost healthcare staffing at VA facilities to improve access to care and care coordination. The collaboration agreement...

CMS Expects to Release MIPS Participation Status By May 2017


CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement (via...


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