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

Policy & Regulation News

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


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


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


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


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


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


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


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


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


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


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


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...

CMS to Up Medicare Payments, Reduce Burdens for Inpatient Rehabs


CMS is seeking to reduce the administrative burden for inpatient rehabilitation facilities on top of a proposed $75 million Medicare payments increase in the 2019 fiscal year. The federal agency released several proposed rules for...

Rural Hospitals Get Low-Volume, Medicare-Dependent Funds Extended


While the recent 2019 Medicare Inpatient Prospective Payment System (IPPS) rule brought major changes to healthcare price transparency and meaningful use, the rule also extended two key payment programs for small and rural hospitals. Those...

“Just the Beginning” of Healthcare Price Transparency, Verma Says


Requiring hospitals to post a list of their standard charges online is just the beginning of the push for increased healthcare price transparency by CMS, explained the federal agency’s Administrator Seema Verma. “As people are...

CMS to Require Healthcare Price Transparency Online for Hospitals


CMS is updating its healthcare price transparency guidance to hospitals in a new proposed rule. The rule would require hospitals to make a list of their standard charges public via the Internet. Through guidelines, the federal agency...

Banner Health Pays $18M to Resolve Medicare Fraud Accusations


Banner Health, one of the largest non-profit hospital systems in the country, recently agreed to pay $18 million to the federal government to resolve Medicare fraud allegations involving 12 of its hospitals in Arizona and Colorado, the...

Judge Asks AHA to Develop Medicare Appeals Backlog Solutions


A federal judge is calling on the American Hospital Association (AHA) to recommend strategies to reduce the growing Medicare appeals backlog, a recent court order stated. According to the AHA’s website, US District Judge James...

House Reps Create Caucus for Value-Based Reimbursement, Health IT


Four House Representatives recently announced the creation of a new bipartisan group dedicated to supporting and promoting healthcare innovation through value-based reimbursement. Representatives Mike Kelly (R-PA), Ron Kind (D-WI),...

Judge Voids CMS Rule Altering Medicaid DSH Payment Calculations


A US District Court for Washington DC recently vacated a CMS final rule from 2017 that required third-party payments, including those from Medicare, to be used when calculating hospital-specific limits on Medicaid Disproportionate Share...

Senators Ask for Help with Quality, Healthcare Price Transparency


A bipartisan group of six senators recently penned a letter to healthcare stakeholders calling for more information on healthcare price transparency to guide and inform a new legislative initiative. Senators Bill Cassidy, MD (R-LA),...

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