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

Policy & Regulation News

HRSA Awards $293M to Bolster the Primary Care Workforce


The Health Resources and Services Administration (HRSA) is looking to bolster primary care by awarding $293 million to expand the primary care workforce, HHS recently announced. The healthcare industry is facing a serious physician...

CMS to Extend Healthcare Price Transparency to Prescription Drugs


CMS is attempting to extend healthcare price transparency to prescription drugs. According to a recently proposed rule, drug manufacturers may have to start including the list price for the medications they advertise on television. As...

Senator Urges FTC to Investigate Hospital Contracting Practices


Senate Judiciary Committee Chairman Chuck Grassley (R-IA) recently called on the Federal Trade Commission (FTC) to investigate whether hospitals and payers in the US are deliberately engaging in anticompetitive hospital contracting...

Medicare DSH Payment Case Makes Its Way to the Supreme Court


The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request from HHS to revisit an appellate...

CMS Clarifies Healthcare Price Transparency Rules for Hospitals


CMS recently expanded on new healthcare price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the...

CMS Finds Errors in 2019 MIPS Payment Adjustment Calculations


CMS recently announced that it is extending the targeted review deadline for 2017 Merit-Based Incentive Payment System (MIPS) performance feedback after the federal agency identified three errors with the scoring logic for the 2019 payment...

CMS Floats Rule to Save Providers $1.1B, Cut Administrative Burden


Healthcare providers are slated to save an estimated $1.12 billion annually under a recently proposed rule from CMS that would reduce administrative burdens. The savings would stem from proposals to simplify and streamline...

Policymakers Concerned with ACO Shared Savings Under Updated MSSP


The House Committee on Ways and Means recently voiced concerns that proposed changes to the shared savings arrangements under the Medicare Shared Savings Program (MSSP) overhaul would harm accountable care organizations (ACOs). In a...

Do Hospital Mergers, Acquisitions Increase Prices, Reps Ask MedPAC


Energy and Commerce Committee leaders are calling on the Medicare Payment Advisory Commission (MedPAC) to settle the debate on whether hospital mergers and acquisitions raise prices for patients. In a recent letter to MedPAC’s...

OIG Mulls Anti-Kickback Statute Changes to Boost Value-Based Care


HHS is looking to make sweeping changes to healthcare fraud and abuse laws. As the comment period for a CMS Request for Information (RFI) on the Stark Law closed, the HHS Office of the Inspector General (OIG) released a new RFI on the...

CMS Initiative to Create Pediatric APMs to Address Opioid Crisis


A new CMS Innovation Center initiative will call on local stakeholders and Medicaid agencies to develop alternative payment models that address the impact of the opioid crisis for children, CMS recently announced. Medicaid and local...

Leading Accountable Care Organization Group Opposes MSSP Overhaul


The proposal to overhaul the Medicare Shared Savings Program (MSSP) would significantly harm the accountable care organization (ACO) movement, the National Association of ACOs (NAACOS) recently stated. “The administration’s...

CMS Plans to Transform MSSP to Encourage ACOs to Assume More Risk


CMS recently proposed an overhaul of Medicare’s largest accountable care organization (ACO) program, transforming it from the Medicare Shared Savings Program (MSSP) to the Pathways to Success initiative. The redesigned MSSP program...

How Can CMS Improve MACRA’s Quality Payment Program, MIPS?


While providers commend CMS for replacing the Sustainable Growth Rate with MACRA and its Quality Payment Program, many still have some reservations about the Medicare program. After completing the first Quality Payment Program performance...

AHA: Create Stark Law Exception for Value-Based Reimbursement


The American Hospital Association (AHA) recently urged CMS to modify the Stark Law by adding value-based reimbursement exceptions that enable providers to coordinate care and advance patient outcomes.   “To reach the full...

CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost


CMS recently finalized a rule that will establish more comprehensive healthcare price transparency rules for hospitals. In the final rules on the Medicare prospective payment systems for the inpatient (IPPS) and long-term care (LTCH PPS)...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value


CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make the move by implementing the...

Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals


Focusing healthcare payment reforms efforts on providers, rather than hospitals, will be key to lowering healthcare costs, CMS Administrator Seema Verma recently told stakeholders. “Over the coming months, we will create new...

CMS Proposes to Extend Site-Neutral Payments to Clinic Visits


CMS recently proposed to implement site-neutral payments for clinic visits provided at off-campus provider-based hospital departments. According to a recently proposed CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS)...

Industry Orgs Fight Anthem’s Emergency Department Payment Policy


The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the payer to retroactively deny emergency...

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