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

Policy & Regulation News

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),...

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules


A District Court in Missouri prohibited CMS from enforcing a 2017 final rule and two Frequently Asked Questions (FAQs) from 2010 that would alter the formula for calculating hospital-specific limits for  Medicaid reimbursement under...

DoJ Memo Limiting Guidance Use to Impact Healthcare Fraud Cases


A recent Department of Justice (DoJ) memo limiting the use of regulatory guidance to pursue affirmative civil enforcement cases could alter the federal government’s approach to healthcare fraud litigation. The document from...

Medicare Spending, Prices Drive Healthcare Spending Growth


The healthcare share of the economy should reach 19.7 percent by 2026 as the average annual rate of national healthcare spending growth rate and Medicare spending accelerates, the CMS Office of the Actuary recently projected. The data,...

Drug Prices, Medicaid Reform Major Themes in Trump’s HHS Budget


President Trump plans to decrease HHS funding by about 21 percent compared to 2017, while focusing the federal department’s budget on prescription drug prices reductions and Medicaid reform, according to the 2019 fiscal year budget...

How the Bipartisan Budget Act of 2018 Impacts Claims Reimbursement


After facing two government shutdowns this year, Congress passed a long-term budget deal and President Trump signed it into law early on Feb. 9, 2018. While the Bipartisan Budget Act of 2018 included plans for avoiding another shutdown and...

CMS Extends Home Health Enrollment Suspension to Combat Fraud


In an effort to reduce Medicare fraud, CMS announced in a new rule that it will extend a moratorium on enrollment of new Medicare home health agencies in Florida, Illinois, Michigan, and Texas. The federal agency also suspended enrollment...

VA Leverages CMS Data Analytics to Reduce Healthcare Fraud, Waste


The country’s two largest public-private healthcare payment systems, the VA and CMS, recently announced that they will partner to reduce healthcare fraud, waste, and abuse for veterans using data analytics tools. “The VA-HHS...

Senate Confirms Former Pharma Exec Alex Azar as Next HHS Secretary


Former Eli Lilly executive Alex Azar will now head the Department of Health and Human Services (HHS) after Senators confirmed his nomination this afternoon in a 55 to 43 vote. The Trump Administration nominated Azar back in November 2017...

Voluntary Bundled Payments Launch, HHS Nominee Backs Mandatory APMs


CMS announced a new voluntary bundled payments opportunity starting in late 2018 on the same day that HHS Secretary nominee Alex Azar seemingly backed mandatory alternative payment models during a Senate Finance committee hearing. The new...

Hospital Closures Increased in States Without Medicaid Expansion


Hospitals in Medicaid expansion states were six times, or about 84 percent, less likely to face hospital closures than their peers in non-expansion states, a new Health Affairs study showed. The hospital closure rate decreased by 0.33 per...

New CO Law Requires Providers to Give Patients Healthcare Prices


A new healthcare price transparency law in Colorado now requires providers to give patients the costs of the most common procedures they perform. Patients should receive a list of the prices for the 15 most common services delivered at...

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