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

Policy & Regulation News

Deloitte: Only Half of Physicians Have Heard of MACRA

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Despite the significance of its provisions, many healthcare providers are still unaware of MACRA and the federal government's plans to eliminate the sustainable growth rate and offer new alternative payment models to eligible...

FTC: States Should Avoid Agreement Laws on Hospital Mergers

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The Federal Trade Commission has made clear its stance on certain state laws governing hospital mergers while at the same time dismissing a complaint against the merger of Cabell Huntington Hospital and St. Mary’s Medical Center. The...

CMS Proposes Medicare Payment Reform Rule for Primary Care

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In efforts to better support primary care physicians, CMS has announced a proposed Medicare payment reform rule that would improve payment accuracy for providers who treat chronically ill and medically complex patients. The rule would...

CMS Proposes to Update Medicare Reimbursement Rates for OPPS

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According to a press release, CMS has proposed changes to Medicare reimbursement rates and policies in the Hospital Outpatient and Ambulatory Surgical Centers prospective payment systems. The agency stated that the proposals account for...

Providers Pay Millions to Resolve Medicare Fraud Cases

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Healthcare fraud, abuse, and waste can cost the government millions, but recently, federal agencies have made catching and preventing Medicare fraud a top priority. Last month, the Department of Justice partnered with the Department of...

AHA: Healthcare Fraud Laws Impede Value-Based Care Success

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For alternative payment models under MACRA to succeed, the federal government needs to revise healthcare fraud and abuse prevention laws to work with new value-based care strategies, explained the American Hospital Association (AHA) in a...

House Reps Ask for FFS Waivers for Alternative Payment Models

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CMS should make it easier for fee-for-service providers to get involved in risk-based alternative payment models by reducing regulatory barriers, House representatives said in a letter this week. The seventy representatives asked CMS to...

CMS Selects 200 Groups for Value-Based Care Oncology Model

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The Centers for Medicare and Medicaid Services (CMS) has announced that almost 200 physician groups and 17 health insurance companies will join the Oncology Care Model, a value-based care program starting in July for providers who furnish...

Finding a Place for Bundled Payments in MACRA Implementation

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As officials at the Centers for Medicare and Medicaid Services (CMS) sift through over 3,800 comments on the proposed rule for MACRA implementation, the Healthcare Incentives Improvement Institute (HCI3) has released its comment letter to...

AMA Voices Concerns Over MACRA Implementation, MIPS, APMs

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As the comment period for the proposed Medicare Access and CHIP Reauthorization Act (MACRA) came to a close earlier this week, the American Medical Association (AMA) expressed some concern with MACRA implementation and its specific...

CMS Targets Medicare Payment Reform for Home Health

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By 2017, home health agencies could see a 1.0 percent, or $180 million, reduction in reimbursements due to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that mandates Medicare payment reform. In a recent fact...

CMS: Proposed Changes to Dialysis, ESRD Claims Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) has recently announced proposed changes to claims reimbursement models for end-stage renal disease (ESRD) and dialysis as well as revisions to the competitive bidding program for durable...

House Reps Introduce Healthcare Transparency, Cost Info Bill

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With more individuals covered by a health insurance plan and high-deductible arrangements on the rise, patients and beneficiaries are increasingly demanding more healthcare transparency when it comes to costs of services and out-of-pocket...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

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The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on...

CMS Proposes Revisions to Medicaid Improper Payment Programs

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The Centers for Medicare and Medicaid Services (CMS) is calling on healthcare stakeholders to comment on a proposed rule that would change how states identify improper payments stemming from Medicaid and Children’s Health Insurance...

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...

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...

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,...

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...

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...

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