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

Policy & Regulation News

CMS: Medicare Accountable Care Organizations Saved Over $466M


Medicare accountable care organizations (ACOs) saved more than $466 million in 2015, with 125 ACOs qualifying for shared savings payments under the value-based care model, CMS reported in an announcement earlier this week. “The...

AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+


The American Medical Group Association (AMGA) has called on CMS to release the claims reimbursement formula for the Comprehensive Primary Care + (CPC+) model, according to a letter sent to the federal agency earlier this week. The...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes


CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to 2,022 hospitals to end the appeals...

CMS Prepares Providers for End of ICD-10 Coding Flexibilities


Starting on October 1, CMS plans to thaw the freeze on ICD-10 implementation by adding more codes and allowing review contractors to deny claims based on level of specificity. To help healthcare providers prepare for updates to ICD-10...

Patients Led to Private Plans to Boost Claims Reimbursement?


The federal agency is investigating whether some healthcare providers or provider-affiliated organizations are encouraging individuals eligible for Medicare and/or Medicaid to enroll in individual market plans under the Affordable Care Act...

$17B Increase in Medicare Part D Prescription Drug Spending


Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan


CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal...

Cardiac Care Bundled Payment Model to Generate Modest Savings


The recently proposed Medicare bundled payment model for cardiac care will likely bring only modest shared savings or losses to participants, according to a study from Avalere Health. About 85 percent of providers that will be required to...

Value-Based Care Penalties Spark Greater Quality Improvements


Financial penalties may be the key to advancing value-based care goals, such as reducing hospital admissions, according to a recent study in the American Journal of Managed Care. Almost two-thirds of hospital leaders stated that the...

At-Home Service Value-Based Care Model Saves Medicare $10M


A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending. Medicare saved $10 million during...

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?


Many long-term acute care facilities are projected to close over the next few years as Medicare enacts a payment reform rule that will introduce site-neutral payments for certain long-term acute care services, according to a Standard &...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement


States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States


To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its website. “CMS is continuing its...

CMS Final Rule Updates Inpatient Claims Reimbursement System


Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the...

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts


Over 120 general acute care hospitals have filed a lawsuit against Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell over Medicare reimbursement reductions under the two-midnight rule. The two-midnight rule...

GAO: Medicare Uncompensated Care Aid Not Based on Actual Costs


Medicare’s uncompensated care payments to hospitals do not account for the actual healthcare costs associated with treating large proportions of Medicaid and uninsured patients, according to a recent Government Accountability Office...

CMS Opens Enrollment for Value-Based Primary Care Model


CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September...

CMS Issues Final Changes for Medicare Reimbursement Programs


CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website. Healthcare providers in the...

CMS Updates Part A Claims Reimbursement, Auditing Policies


To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will be limited to a six-month look-back...

How CMS Would Reimburse ACOs for Value-Based Care under MIPS


With a final rule on implementing MACRA coming in the next couple of months, some accountable care organizations (ACOs) have started to analyze new value-based reimbursement structures under the proposed rule. While only a couple of...

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