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

Policy & Regulation News

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

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CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual...

Hospitals to See More 340B Drug Pricing Program Oversight, Azar Says

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According to HHS Secretary Alex Azar, hospitals should expect greater transparency and oversight of the 340B Drug Pricing Program to track how the program’s benefits are used to improve care for low-income and vulnerable...

CMS Aims to Protect Medicaid Payments to Providers, Not 3rd Parties

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CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed regulatory change to the Medicaid...

CMS Postpones Deadlines for New Bundled Payments Model

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Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced...

CMS Proposes New Grouping Model for Medicare Home Health Payments

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CMS recently proposed a rule that would implement the Patient-Driven Groupings Model for Medicare home health payments by 2020. The rule would eliminate the current Medicare reimbursement system for home health agencies, which pays home...

AHA Finds Flaws with the Patient-Driven Payment Model for SNFs

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CMS is in the process of redesigning Medicare reimbursement systems for post-acute care facilities, but the American Hospital Association (AHA) is taking issue with the federal agency’s latest attempt to tie skilled nursing facility...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

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In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according to a recent announcement from the...

Relaxing Scope of Practice Laws for APRNs, PAs to Boost Efficiency

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Loosening scope of practice laws for advanced practice registered nurses and physician assistants and shifting spending away from physicians can boost provider productivity, driving down costs, the economic policy center The Hamilton...

AMIA Calls for Activity Reporting in Promoting Interoperability

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CMS should replace process measure reporting in the new Promoting Interoperability program with activity-based reporting as in the Improvement Activities performance category of Merit-Based Incentive Reporting System (MIPS), the American...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs

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CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is...

Antitrust Case Before Supreme Court May Limit Physician Referrals

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An antitrust case involving credit card companies could potentially impact healthcare by allowing payers and hospital systems to limit physician referrals. Ohio v. American Express Co. is a pending case before the Supreme Court that...

NJ Passes Healthcare Price Transparency Law to Stop Surprise Bills

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New Jersey policymakers are increasing healthcare price transparency in the state by enacting a new law intended to protect consumers from surprise bills for out-of-network health services. New Jersey Governor Phil Murphy signed Assembly...

CMS Accounts for Extreme Situations in CJR Bundled Payments

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CMS updated rules for the Comprehensive Care for Joint Replacement (CJR) bundled payments model to protect participating hospitals from uncontrollable episodes costs incurred during an emergency period, like the recent Hurricanes or...

HHS Mulls Private Sector Dialogue to Foster Healthcare Innovation

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HHS is floating the idea of creating a workgroup of private healthcare companies to advise the federal department on healthcare innovation and investment, according to a new Request for Information (RFI) notice. The federal department is...

Medicare Fund for Hospital Care to Run Out Sooner Than Expected

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The Medicare fund used to reimburse hospitals under Part A is slated to become insolvent by 2026, three years earlier than last year’s projection, a new report by the Trustees of Medicare and Social Security revealed. The...

CMS Proposes New Pre-Claim Review for Home Health Agencies

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CMS is floating the idea of implementing another pre-claim review of Medicare claims submitted by home health agencies in at least five states, according to a recent notice of proposed information collection. The federal agency proposed...

AMGA Suggests CMS Improve ACOs, Medicare Shared Savings Program

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The American Medical Group Society (AMGA) recently recommended CMS focus on improving accountable care organizations (ACOs) and the Medicare Shared Savings Program (MSSP) rather than put forth a new direct provider contracting (DPC)...

Pres Trump Eyes 340B Drug Reforms to Lower Prescription Drug Costs

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The 340B Drug Pricing Program could face some changes under the Trump Administration’s latest plan to reduce prescription drug costs. The United States had the highest per-capita prescription drug spending in 2015, the President...

HRSA Proposes Fifth Delay of 340B Drug Pricing, Penalty Rule

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The Health Resources and Service Administration (HRSA) recently proposed a one-year delay of a final rule that would implement 340B drug pricing rules and civil monetary penalties for drug manufacturers that intentionally overcharge...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

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Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma...

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