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

Policy & Regulation News

Healthcare Execs Ponder Financial Impact of Possible ACA Repeal

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With a possible full or partial Affordable Care Act repeal in the near future, healthcare executives called for some of the healthcare reform law’s provisions to continue, such as increased insurance coverage and the value-based...

Hospitals, Health Systems Eye Financial Snags in ACA Repeal

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In identical letters to the Trump Administration and Congress, the American Hospital Association and other state and regional associations are urging members of both branches of the federal government to continue working on...

Executive Order Calls for ACA Financial, Marketplace Flexibility

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Just hours after taking office, President Trump signed a broad executive order that intends to minimize the “economic burden of the Patient Protection and Affordable Care Act” before an official repeal of the law. Under the...

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

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A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative law judge level. HHS projected the...

HRSA Adds $5K Fines for 340B Prescription Drug Rate Overcharging

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Drug manufacturers participating in the 340B Drug Pricing Program who intentionally charge hospitals prescription drug rates higher than established ceiling prices will face a $5,000 penalty per instance, a new Health Resources and...

VA Gives RNs Full Practice Authority to Improve Care Access

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The Department of Veterans Affairs (VA) will now give some advanced practice registered nurses full practice authority in order to boost care access and quality of care. However, certified registered nurse anesthetists will not benefit...

CMS Hinders Private Plan Steering for Claims Reimbursement Bump

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CMS recently released an interim final rule designed to prevent providers at Medicare-certified dialysis centers from inappropriately steering patients away from Medicare and Medicaid in order to get higher claims reimbursement rates under...

AHA, FAH: ACA Repeal Could Cost Hospital Revenue Cycle Billions

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Providers could face billions in hospital revenue cycle losses if the Affordable Care Act is repealed without replacement legislation that preserves health coverage increases and rolls back claims reimbursement cuts, stated the American...

AHA Calls for Value-Based Reimbursement Reform Under Trump

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In a recent letter to President-Elect Trump, the American Hospital Association (AHA) urged the upcoming administration to continue the value-based reimbursement transition by developing more effective alternative payment models, promoting...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

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The American Hospital Association (AHA) recently called on Congress to pass several healthcare payment reform bills, such as the Helping Hospitals Improve Patient Care Act and the Sustaining Healthcare Integrity and Fair Treatment Act of...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

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The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention...

WEDI: ICD-10 Coding Guideline Negates Some Claim Audit Policies

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A new ICD-10 coding guideline conflicts with reporting and auditing policies for several quality programs as well as medical necessity rules and other healthcare regulations, stated the Workgroup for Electronic Data Interchange (WEDI) in a...

CMS Finalizes MACRA Implementation, Quality Payment Program

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CMS released the long-awaited final rule on MACRA implementation earlier today, which stated that the new value-based reimbursement system will start on Jan. 1, 2017. The final MACRA implementation rule will replace the Sustainable Growth...

GOP Doctors Caucus Suggests MACRA Implementation Changes

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In a recent letter to CMS Acting Administrator Andy Slavitt and Director of the Office of Management and Budget Shaun Donovan, the GOP Congressional Doctors Caucus called for several MACRA implementation changes to make the...

GAO: Healthcare Spending Data from CMS Inaccessible, Unreliable

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CMS should make healthcare spending data for skilled nursing facilities more accessible to public stakeholders and ensure the expenditure information is reliable, the Government Accountability Office (GAO) advised the federal agency in a...

House Reps Urge CMMI to Cease Mandatory Payment Reform Models

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In a recent letter to CMS leaders, House representatives urged the federal agency to stop all mandatory payment reform demonstrations through the Center for Medicare and Medicaid Innovation (CMMI), such as the ongoing Comprehensive Care...

House Reps Introduce Medicare ACO Improvement Legislation

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House representatives Diane Black (R-TN) and Peter Welch (D-VT) introduced a bill last week that would change the rules for Medicare accountable care organizations (ACOs). The ACO Improvement Act of 2016 contains reforms for Medicare...

Provider Org Pays $3M for Violating Medicare Fraud Resolution

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Kindred Healthcare, Inc., the country’s largest provider of post-acute care, recently paid more than $3 million for failing to comply with a Medicare fraud resolution agreement. It represents the largest penalty ever doled out by the...

CMS Proposes to Expand Medicaid Fraud Control Unit Authority

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A recently proposed rule would codify several statutory changes involving Medicaid Fraud Control Units, including the authority to investigate patient and abuse cases at healthcare facilities regardless of if they receive...

CMS Must Inform Providers on New Medicare Reimbursement Policy

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A Vermont judge has ordered CMS to further educate providers and auditors about a recent Medicare reimbursement policy that affects skilled nursing and rehabilitation facilities, reported the Center for Medicare Advocacy. The court stated...

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