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

Policy & Regulation News

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

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The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues with...

Uncompensated Care Drops by $6B after Medicaid Expansion

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Numerous individuals seek necessary medical services at hospitals regardless the ability to pay, but uncompensated care costs from charity cares and patient debt can strain hospital revenue cycles. However, as states develop Medicaid expansion...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

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A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week, Medicare reimbursement...

CMS Announces Pre-Claims Reimbursement Review for Home Health

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In efforts to combat Medicare fraud and provide more timely care to beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has issued a rule that requires some home health agencies to undergo a pre-claim review to qualify for full...

Coding Productivity Fell by 14% After ICD-10 Implementation

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As the anniversary of ICD-10 implementation approaches, a survey from the American Health Information Management Association (AHIMA) Foundation has revealed that coding productivity and accuracy has marginally declined since ICD-10 began. “Health...

60% of RAC Reviewed Claims Showed No Medicare Overpayments

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Reducing healthcare fraud, waste, and abuse has recently been on the top of the CMS agenda, but some healthcare providers are questioning how effective some CMS initiatives are at identifying potential Medicare overpayments. The American Hospital...

Medicare Payment Reform Bill for Hospitals Moves to Senate

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The House of Representatives recently passed the Helping Hospitals Improve Patient Care Act, which proposes Medicare payment reform for off-campus hospital outpatient departments, hospitals with excessive readmissions, and rural hospitals. The...

New DMEPOS Prices Reduce Medicare Spending, Ensure Care Access

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Riding on the success of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), CMS has announced that expanding competitive bidding prices for DMEPOS items nationwide has continued to reduce...

OIG: CMS Lacked Good Management Policies for Pioneer ACO Model

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The Pioneer Accountable Care Organization (ACO) program faced a number of management and leadership challenges during its early days, according to a report from the Office of the Inspector General (OIG).  The report indicates CMS faced several...

Medicare Shared Savings Program Gets New Cost Calculations

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The Centers for Medicare and Medicaid Services (CMS) has recently finalized a rule that will change the methodology for calculating costs under Medicare Shared Saving Program, the federal agency announced. MSSP accountable care organizations...

How to Manage ICD-10 Implementation Updates, Maximize Revenue

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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...

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