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

Policy & Regulation News

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,...

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments


On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that addresses the problematic two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule would...

CMS Proposes New Quality Reporting for Skilled Nursing Facilities


CMS is hoping to bring more value-based care to skilled nursing facilities by issuing a proposed rule that raises the bar on quality reporting programs for these providers. As part of the Improving Medicare Post-Acute Care Transformation Act...

AHIMA Proposes Revisions to New Group of ICD-10-PCS Codes


Six months after the healthcare industry managed to make its initial transition to ICD-10 with few significant issues, CMS is planning to lift its freeze on the addition of new codes. Approximately 5000 new codes will join the existing ICD-10-CM...

Providers Need Time, Resources for MACRA Implementation


Driven by the Affordable Care Act, the implementation of Medicare Access and CHIP Reauthorization Act (MACRA) is expected to significantly impact the nation's healthcare system. Already, many physicians and various types of healthcare...

Patient Scheduling Still Problematic at VA Medical Settings


In a perfect world, the Department of Veterans Affairs’ (VA) patient scheduling system works effectively so veterans are able to access primary care physicians easily. Unfortunately, many veterans continue to face extremely long wait times...

House Requests CMS Delay Quality, Value-Based Care Ratings


A group of 225 members of the House of Representatives recently wrote a letter urging CMS it to delay the release of the hospital star rating system because it does not include relevant quality measures for assessing value-based care and the...

CMS Extends Deadline for Bundled Payment Models Participation


The federal government especially the Centers for Medicare & Medicaid Services (CMS) have long focused on reducing healthcare spending and implementing alternative payment models such as pay-for-performance initiatives. Bundled payment models,...

States Could Build Upon the Affordable Care Act to Cut Costs


The Affordable Care Act has had two main goals for the healthcare system: Increase health insurance coverage for Americans and lower healthcare spending around the country. At this point in time, the Affordable Care Act has brought health coverage...

How to Reduce Wasteful Spending in the Medicare Program


When the Affordable Care Act was passed several years ago, it had major implications for the future of the Medicare program. According to a study from the Private Enterprise Research Center at Texas A&M University, the Affordable Care Act...

ICD-10 System Codes Will See New Updates by October 1


The ICD-10 implementation deadline and postponements brought a variety of challenges to the healthcare field. One of those obstacles has been the constant ICD-10 system code freezes. However, on October 1, 2016, the healthcare industry will move...

CMS May Save $343 Million through Surgical Bundled Payments


The Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Care for Joint Replacement Model a little more than a week ago. This program is meant to issue bundled payments for a particular episode of care - in this case,...

Does Medicaid Expansion Improve Revenue of Hospitals?


The Affordable Care Act and Medicaid expansion has had a significant impact on hospitals around the country since full coverage for millions of Americans would lead to greater utilization of healthcare services and possibly strain the resources...

21 States Have Overbilled the FFS Medicare Program


New research from the Centers for Medicare & Medicaid Services (CMS) shows that 21 states have above average rates of overbilling the Medicare program. The Supplementary Appendices for the Medicare Fee-for-Service (FFS) Improper Payment Report...

Value-Based Care Final Rule to Implement MACRA Sent to OMB


The final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) — and its provisions for value-based care and reimbursement — is now in the hands of the Office of Management and Budget (OMB) according...

CMS, CDC Add More than 5,000 Codes to ICD-10 Coding System


Last week, the Centers for Disease Control and Prevention along with the Centers for Medicare & Medicaid Services (CMS) announced some major news for the ICD-10 coding system. The two organizations have added more than 5,000 new ICD-10 diagnosis...

Medicare Spending Increases Slightly under Affordable Care Act


In 2014, Medicare spending for personal healthcare expenditures only increased by 2.4 percent per person and decreased by 3.6 percent for Medicaid, a recent report by the Department of Health and Human Services (HHS) stated. In comparison, overall...

Health Insurance Exchange Tips for Taxpayers Before April 15


With the deadline for filing this year’s taxes just around the corner, it is useful for insurance consumers to refresh the requirements of tax filing when covered through the health insurance exchange. The majority of people who purchase...

CMS Details How to Resolve ICD-10 Implementation Issues


In the second update about ICD-10 implementation, CMS has released infographic and statement guidance on how to address issues and questions about IDC-10. The recent statement encourages providers to create a feedback system to review clinical...

House Budget Proposes ACA Repeal, Reduced Medicare Spending


The House of Representatives proposed budget plan for 2017 from the House Budget Committee aims to repeal the Affordable Care Act (ACA), reduce Medicare spending, and give states more control with health programs. “With respect to health...


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