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

Policy & Regulation News

How to Manage ICD-10 Implementation Updates, Maximize Revenue


Just as most healthcare stakeholders reported that ICD-10 implementation ran smoother than expected, CMS will be releasing 5,500 new codes beginning in October. While it may sound like a large update to the system, the new codes could help providers...

Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud


Using big data tools and predictive analytics, the Centers for Medicare and Medicaid Services (CMS) has saved approximately $1.5 billion by preventing Medicare fraud in the traditional fee-for-service program, according to the official CMS blog....

Congress Asks CMS to Scrap Prior Authorization for Home Health


A CMS proposal to require a prior authorization screening for every home health service would be an administrative nightmare and may produce barriers to care for needy patients, a group of 116 lawmakers said in a letter to CMS this week. "This...

GAO: Weak Medicare, Medicaid Provider Screening Allows Fraud


The Centers for Medicare & Medicaid Services’ (CMS) provider enrollment screening process is vulnerable to fraud because many ineligible providers are still being entered into the Provider Enrollment, Chain and Ownership System (PECOS),...

Newly Launched MACRA Initiative Aims to Support Providers


On May 25, American Medical Group Association (AMGA) launched a resource to help its members prepare for MACRA implementation as well as all risk-based payment systems. “We are making it our priority to ensure our members have the tools...

OIG: CMS Not Reducing Medicare, Medicaid Improper Payments


In testimony submitted to House of Representatives Subcommittee on Oversight and Investigations, the Office of Inspector General (OIG) urged the Centers for Medicare & Medicaid Services to work with states to correct gaps in their...

Proposed Bill Seeks Medicare Payment Reform for Hospitals


Potential reform is coming to help hospitals avoid getting penalized for high admission rates among low-income patient populations. On May 18, two members of the House of Representatives Health Subcommittee — Representatives Pat Tiberi...

CPC Initiative Improves Care Delivery But Not Medicare Spending


Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers from The New England Journal of Medicine...

Improper Medical Billing for DMEPOS Costs Medicare Billions


Medicare continues to lose billions as a result of improper medical billing for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), according to the Council for Medicare Integrity. Specifically, the Medicare program had...

For Truly Value-Based Care, Use Outcomes Instead of Processes


Value-based care is the goal of many of the nation’s healthcare reform efforts, yet basing regulatory changes and provider-facing metrics on checking off processes instead of achieving outcomes could be the wrong approach, states a new...

AHA: MACRA Alternative Payment Model Incentives Need Changing


The MACRA Alternative Payment Model incentives should be implemented in a way that provides the best opportunity for physicians to become qualifying participants, the American Hospital Association argued in a letter to CMS this week MACRA provides...

Expert Seeks Payment Reform in Light of Healthcare Mergers


Payment reform might be one way to tackle the issue of rising medical costs that have been coming as a result of healthcare mergers. It’s possible for this issue to be resolved if the federal government pursued policies to foster competition...

ICD-10 Implementation Ran Smoother than Originally Expected


On May 9, the Workgroup for Electronic Data Interchange (WEDI), announced that the ICD-10 implementation process was moderately smooth because costs were mostly in line with expectations and testing improved. Additionally, productivity levels...

GAO: Millions Spent Yearly on Ineligible Medicaid Reimbursements


Ineligible managed care providers currently receive $3 million in Medicaid reimbursements annually, the Government Accountability Office (GAO) said in a report, due to the lack of effective screening processes. “The integrity of the Medicaid...

Are Healthcare Fraud and Abuse Rates on the Decline?


If trends persist, 2016 is looking set to have the lowest level of federal prosecutions for healthcare fraud since 1998, according to Transactional Records Access Clearinghouse (TRAC). TRAC, which is a research organization at Syracuse University,...

Providers Collect More Revenue Due to ACA Medicaid Expansion


In recent years, the Affordable Care Act (ACA) paved the way for significant Medicaid expansion. A recent study from the National Bureau of Economic Research found that Medicaid expansion resulted in financial benefits for low-income patients...

How MACRA, MIPS Will Impact Critical Access Hospitals, FQHCs


MACRA means different things to various types of healthcare providers, such as critical access hospitals, rural health clinics and Federally Qualified Health Centers. Although the new MACRA framework provides multiple paths to success with various...

Top 5 Facts to Know about MACRA Alternative Payment Models


CMS recently proposed a rule that would put last year's MACRA's legislation into action. The proposal introduces several significant changes to the way providers will attest to quality improvements and technology use, but also includes...

MACRA Quality Payment Program Promotes Alternative Payment Models


The newly-proposed MACRA implementation rule establishes the Quality Payment Program and shines a spotlight on alternative payment models for Medicare. Alternative payment models (APMs) are a central feature of new proposed rule for implementation...

CMS Payment Reforms Mean Big Bucks for Medicare, Medicaid


Over the past month, CMS has announced finalized and proposed rules that would significantly impact payment policies in 2017 for managed care in Medicaid and the Children’s Health Insurance Program (CHIP) as well as Medicare hospice benefits,...


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