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

Policy & Regulation News

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

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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?

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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...

CMS Details Rationale Behind Hospital Quality Ratings

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Just as consumers rate restaurants on Yelp.com on a scale of one to five stars, CMS has published star ratings for healthcare facilities on its Hospital Compare website to boost healthcare transparency. According to CMS leadership, the...

Healthcare Transparency Bill Proposes to Delay Star Ratings

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Two House Representatives, Jim Renacci (R-OH) and Kathleen Rice (D-NY), have recently introduced a healthcare transparency bill that would require CMS to delay the release of new hospital star ratings for another year to ensure that the...

New Rules for Bundled Payment Models for Cardiac, Hip Care

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CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25,...

DOJ Charges 3 Individuals in $1B Medicare Fraud Scheme

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Healthcare fraud, waste, and abuse is known to drain the industry of essential funds, but three individuals have allegedly participated in Medicare fraud and money laundering schemes that have cost the program more than $1...

CMS Saves $42B Through Healthcare Fraud Prevention Activities

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By using a more proactive approach to healthcare fraud protection, CMS has saved the Medicaid and Medicare programs nearly $42 billion in fiscal years 2013 and 2014. In a post on its official blog, CMS attributed the savings to an...

Is MACRA a True Doc Fix for Value-Based Reimbursement?

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Will MACRA be the answer to tying reimbursements to quality care or will it be just end up as another doc fix, like those under the Sustainable Growth Rate program? A recent National Center for Policy Analysis report is critical of...

Medicare ACOs Reduce Healthcare Spending On Complex Patients

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While one of the primary goals of joining an accountable care organization (ACO) is to coordinate care in effort to reduce healthcare spending, many Medicare ACO participants have seen early benefits from the alternative payment...

End-of-Life Medicare Spending 25% Higher for Younger Seniors

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For most providers, it is not surprising that Medicare spending tends to increase in the last year of a beneficiary’s life, especially since this population is more likely to experience a serious illness and multiple chronic...

AHIMA Reviews Top ICD-10 Implementation, Coding Challenges

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In the days leading up to the go-live of ICD-10 implementation, many healthcare providers feared that the new system would decrease productivity and cause more claim denials. However, in the eight months since the launch, most healthcare...

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