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

Policy & Regulation News

GOP Doctors Caucus Suggests MACRA Implementation Changes


In a recent letter to CMS Acting Administrator Andy Slavitt and Director of the Office of Management and Budget Shaun Donovan, the GOP Congressional Doctors Caucus called for several MACRA implementation changes to make the value-based reimbursement...

GAO: Healthcare Spending Data from CMS Inaccessible, Unreliable


CMS should make healthcare spending data for skilled nursing facilities more accessible to public stakeholders and ensure the expenditure information is reliable, the Government Accountability Office (GAO) advised the federal agency in a recent...

House Reps Urge CMMI to Cease Mandatory Payment Reform Models


In a recent letter to CMS leaders, House representatives urged the federal agency to stop all mandatory payment reform demonstrations through the Center for Medicare and Medicaid Innovation (CMMI), such as the ongoing Comprehensive Care for Joint...

House Reps Introduce Medicare ACO Improvement Legislation


House representatives Diane Black (R-TN) and Peter Welch (D-VT) introduced a bill last week that would change the rules for Medicare accountable care organizations (ACOs). The ACO Improvement Act of 2016 contains reforms for Medicare Shared Savings...

Provider Org Pays $3M for Violating Medicare Fraud Resolution


Kindred Healthcare, Inc., the country’s largest provider of post-acute care, recently paid more than $3 million for failing to comply with a Medicare fraud resolution agreement. It represents the largest penalty ever doled out by the Office...

CMS Proposes to Expand Medicaid Fraud Control Unit Authority


A recently proposed rule would codify several statutory changes involving Medicaid Fraud Control Units, including the authority to investigate patient and abuse cases at healthcare facilities regardless of if they receive Medicaid payments.*...

CMS Must Inform Providers on New Medicare Reimbursement Policy


A Vermont judge has ordered CMS to further educate providers and auditors about a recent Medicare reimbursement policy that affects skilled nursing and rehabilitation facilities, reported the Center for Medicare Advocacy. The court stated that...

CMS: Medicare Accountable Care Organizations Saved Over $466M


Medicare accountable care organizations (ACOs) saved more than $466 million in 2015, with 125 ACOs qualifying for shared savings payments under the value-based care model, CMS reported in an announcement earlier this week. “The coordinated,...

AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+


The American Medical Group Association (AMGA) has called on CMS to release the claims reimbursement formula for the Comprehensive Primary Care + (CPC+) model, according to a letter sent to the federal agency earlier this week. The value-based...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes


CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to 2,022 hospitals to end the appeals process...

CMS Prepares Providers for End of ICD-10 Coding Flexibilities


Starting on October 1, CMS plans to thaw the freeze on ICD-10 implementation by adding more codes and allowing review contractors to deny claims based on level of specificity. To help healthcare providers prepare for updates to ICD-10 coding...

Patients Led to Private Plans to Boost Claims Reimbursement?


The federal agency is investigating whether some healthcare providers or provider-affiliated organizations are encouraging individuals eligible for Medicare and/or Medicaid to enroll in individual market plans under the Affordable Care Act in...

$17B Increase in Medicare Part D Prescription Drug Spending


Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription drug spending...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan


CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal agency. The...

Cardiac Care Bundled Payment Model to Generate Modest Savings


The recently proposed Medicare bundled payment model for cardiac care will likely bring only modest shared savings or losses to participants, according to a study from Avalere Health. About 85 percent of providers that will be required to take...

Value-Based Care Penalties Spark Greater Quality Improvements


Financial penalties may be the key to advancing value-based care goals, such as reducing hospital admissions, according to a recent study in the American Journal of Managed Care. Almost two-thirds of hospital leaders stated that the Hospital...

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


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 the...

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?


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 & Poor’s...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement


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 pass-through...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States


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 efforts...


Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks