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

Policy & Regulation News

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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...

State Reviews Beth Israel, Lahey Health Hospital Merger

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The proposed hospital merger between Boston health systems Beth Israel Deaconess and Lahey Health is delayed as the state’s Health Policy Commission reviews the deal for healthcare costs, quality, and care access issues, according to...

GAO Offers Steps to Enhance Medicaid, Medicare Fraud Strategy

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CMS demonstrates a commitment to preventing and combating Medicaid and Medicare fraud, but the federal agency’s anti-fraud efforts only partially align with the Government Accountability Office’s (GAO) Framework for Managing...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models

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CMS recently finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models slated to launch on Jan. 1, 2018 and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment...

AMGA Advises CMS on Including MA Models as Advanced APMs by 2018

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CMS can boost participation in Medicare Advantage alternative payment models in 2018 by creating a submission form that allows providers in the models to apply to participate in MACRA’s Advanced Alternative Payment Model (Advanced...

House Reps Aim to Stop $1.6B Hospital Payment Cut for 340B Drugs

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A new bipartisan bill intends to block CMS from enforcing a $1.6 billion Medicare reimbursement cut under the 340B Drug Pricing Program. Representatives David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392 last week. The...

Pres Trump Taps Former Pharma Exec Alex Azar as Next HHS Secretary

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President Trump recently nominated Alex M. Azar II as the next HHS Secretary, according to multiple news sources. Azar was the former president of Eli Lilly’s American division and a health official in the George W. Bush...

Industry Orgs Concerned with 2018 MACRA Implementation Rule

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Industry groups, including the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA), are questioning if the new 2018 MACRA implementation rule truly promotes value-based care. In recent comments on...

CMS Cancels Home Health Groupings Model, $950M Reimbursement Cut

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CMS recently scrapped the proposed Home Health Groupings Model. The model would have used clinical and patient characteristics rather than the current therapy service use thresholds to determine Medicare reimbursement for home health...

CMS Finalizes 2018 Hospital, Physician Medicare Reimbursement

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In a series of final rules released earlier this month, CMS updated and modified Medicare reimbursement rates for hospitals and physicians in 2018. The rules aim to “reflect a broader Administration-wide strategy to create a...

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