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

Policy & Regulation News

CMS Final Rule Updates Inpatient Claims Reimbursement System

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Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the Medicare Hospital...

Hospitals Fight Two-Midnight Rule, Medicare Reimbursement Cuts

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Over 120 general acute care hospitals have filed a lawsuit against Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell over Medicare reimbursement reductions under the two-midnight rule. The two-midnight rule stipulates...

GAO: Medicare Uncompensated Care Aid Not Based on Actual Costs

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Medicare’s uncompensated care payments to hospitals do not account for the actual healthcare costs associated with treating large proportions of Medicaid and uninsured patients, according to a recent Government Accountability Office (GAO)...

CMS Opens Enrollment for Value-Based Primary Care Model

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CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September 15,...

CMS Issues Final Changes for Medicare Reimbursement Programs

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CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website. Healthcare providers in the Medicare...

CMS Updates Part A Claims Reimbursement, Auditing Policies

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To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will be limited to a six-month look-back period...

How CMS Would Reimburse ACOs for Value-Based Care under MIPS

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With a final rule on implementing MACRA coming in the next couple of months, some accountable care organizations (ACOs) have started to analyze new value-based reimbursement structures under the proposed rule. While only a couple of Medicare...

CMS Details Rationale Behind Hospital Quality Ratings

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Just as consumers rate restaurants on Yelp.com on a scale of one to five stars, CMS has published star ratings for healthcare facilities on its Hospital Compare website to boost healthcare transparency. According to CMS leadership, the federal...

Healthcare Transparency Bill Proposes to Delay Star Ratings

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Two House Representatives, Jim Renacci (R-OH) and Kathleen Rice (D-NY), have recently introduced a healthcare transparency bill that would require CMS to delay the release of new hospital star ratings for another year to ensure that the program’s...

New Rules for Bundled Payment Models for Cardiac, Hip Care

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CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25, 2016, the...

DOJ Charges 3 Individuals in $1B Medicare Fraud Scheme

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Healthcare fraud, waste, and abuse is known to drain the industry of essential funds, but three individuals have allegedly participated in Medicare fraud and money laundering schemes that have cost the program more than $1 billion. According...

CMS Saves $42B Through Healthcare Fraud Prevention Activities

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By using a more proactive approach to healthcare fraud protection, CMS has saved the Medicaid and Medicare programs nearly $42 billion in fiscal years 2013 and 2014. In a post on its official blog, CMS attributed the savings to an increase in...

Is MACRA a True Doc Fix for Value-Based Reimbursement?

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Will MACRA be the answer to tying reimbursements to quality care or will it be just end up as another doc fix, like those under the Sustainable Growth Rate program? A recent National Center for Policy Analysis report is critical of proposed MACRA...

Medicare ACOs Reduce Healthcare Spending On Complex Patients

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While one of the primary goals of joining an accountable care organization (ACO) is to coordinate care in effort to reduce healthcare spending, many Medicare ACO participants have seen early benefits from the alternative payment model. According...

End-of-Life Medicare Spending 25% Higher for Younger Seniors

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For most providers, it is not surprising that Medicare spending tends to increase in the last year of a beneficiary’s life, especially since this population is more likely to experience a serious illness and multiple chronic conditions....

AHIMA Reviews Top ICD-10 Implementation, Coding Challenges

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In the days leading up to the go-live of ICD-10 implementation, many healthcare providers feared that the new system would decrease productivity and cause more claim denials. However, in the eight months since the launch, most healthcare providers...

Deloitte: Only Half of Physicians Have Heard of MACRA

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Despite the significance of its provisions, many healthcare providers are still unaware of MACRA and the federal government's plans to eliminate the sustainable growth rate and offer new alternative payment models to eligible clinicians beginning...

FTC: States Should Avoid Agreement Laws on Hospital Mergers

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The Federal Trade Commission has made clear its stance on certain state laws governing hospital mergers while at the same time dismissing a complaint against the merger of Cabell Huntington Hospital and St. Mary’s Medical Center. The federal...

CMS Proposes Medicare Payment Reform Rule for Primary Care

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In efforts to better support primary care physicians, CMS has announced a proposed Medicare payment reform rule that would improve payment accuracy for providers who treat chronically ill and medically complex patients. The rule would update...

CMS Proposes to Update Medicare Reimbursement Rates for OPPS

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According to a press release, CMS has proposed changes to Medicare reimbursement rates and policies in the Hospital Outpatient and Ambulatory Surgical Centers prospective payment systems. The agency stated that the proposals account for stakeholder...

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