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

Policy & Regulation News

HRSA Adds $5K Fines for 340B Prescription Drug Rate Overcharging

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Drug manufacturers participating in the 340B Drug Pricing Program who intentionally charge hospitals prescription drug rates higher than established ceiling prices will face a $5,000 penalty per instance, a new Health Resources and Services Administration...

VA Gives RNs Full Practice Authority to Improve Care Access

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The Department of Veterans Affairs (VA) will now give some advanced practice registered nurses full practice authority in order to boost care access and quality of care. However, certified registered nurse anesthetists will not benefit from expanded...

CMS Hinders Private Plan Steering for Claims Reimbursement Bump

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CMS recently released an interim final rule designed to prevent providers at Medicare-certified dialysis centers from inappropriately steering patients away from Medicare and Medicaid in order to get higher claims reimbursement rates under the...

AHA, FAH: ACA Repeal Could Cost Hospital Revenue Cycle Billions

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Providers could face billions in hospital revenue cycle losses if the Affordable Care Act is repealed without replacement legislation that preserves health coverage increases and rolls back claims reimbursement cuts, stated the American Hospital...

AHA Calls for Value-Based Reimbursement Reform Under Trump

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In a recent letter to President-Elect Trump, the American Hospital Association (AHA) urged the upcoming administration to continue the value-based reimbursement transition by developing more effective alternative payment models, promoting telehealth,...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

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The American Hospital Association (AHA) recently called on Congress to pass several healthcare payment reform bills, such as the Helping Hospitals Improve Patient Care Act and the Sustaining Healthcare Integrity and Fair Treatment Act of 2016,...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

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The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention inefficiencies....

WEDI: ICD-10 Coding Guideline Negates Some Claim Audit Policies

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A new ICD-10 coding guideline conflicts with reporting and auditing policies for several quality programs as well as medical necessity rules and other healthcare regulations, stated the Workgroup for Electronic Data Interchange (WEDI) in a recent...

CMS Finalizes MACRA Implementation, Quality Payment Program

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CMS released the long-awaited final rule on MACRA implementation earlier today, which stated that the new value-based reimbursement system will start on Jan. 1, 2017. The final MACRA implementation rule will replace the Sustainable Growth Rate...

GOP Doctors Caucus Suggests MACRA Implementation Changes

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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

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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

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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

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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

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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

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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

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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

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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+

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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

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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

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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...

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