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

Policy & Regulation News

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...

CMS Issues 2018 MACRA Implementation, Quality Payment Program Rule

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CMS recently issued a final 2018 MACRA implementation rule, detailing the requirements for Quality Payment Program participation in 2018. “CMS listened to feedback from the healthcare community and used it to inform policy...

AMGA to Reps: Pass CHRONIC Care Act to Aid ACOs, Team-Based Care

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AMGA recently pushed House Representatives to pass the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which would particularly support accountable care organizations (ACO) implementing...

Over 1,300 Hospitals Urge CMS to Withdraw 340B Drug Payment Cuts

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Over 1,300 rural hospitals and other healthcare organizations that serve low-income communities added their voices to the growing list of stakeholders opposing proposed payment cuts to the 340B Drug Pricing program. CMS proposed in July...

100+ Medical Orgs Want MACRA Implementation Flexibilities Extended

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Over 100 medical organizations recently called on House Representatives to extend MACRA implementation flexibilities that allow HHS leaders to gradually implement full program requirements. The flexibilities should go on for another three...

Healthcare Price Growth Hits Lowest Rate in About Two Years

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Healthcare price growth in August 2017 increased by just 1.2 percent compared to the previous year, reaching the lowest growth rate in nearly two years and only three-tenths above the lowest growth rate ever recorded by Altarum...

MedPAC Calls for MIPS Repeal, Voluntary Program Replacement

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The Affordable Care Act isn’t the only health policy facing a call for repeal and replace. The Medicare Payment Advisory Commission (MedPAC) recently urged HHS to repeal MACRA’s Merit-Based Incentive Payment System (MIPS) and...

Healthcare RCM Vendors ZirMed and Navicure Announce Merger

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Healthcare revenue cycle management vendors Navicure and ZirMed recently announced that the organizations signed a definitive agreement to merge. Navicure will supposedly acquire ZirMed in a deal that values at about $750 million, sources...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

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  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

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In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

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The CMS Advisory Panel on Hospital Outpatient Payment recently called on the federal agency to abandon proposed changes to the 340B Drug Pricing Program in 2018, which would reduce Medicare reimbursement to qualifying hospitals for drugs...

Scarce Public Health Funds Block Social Determinants of Health Aid

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As value-based care emphasizes preventative medicine, healthcare stakeholders aim to address social determinants of health to improve and maintain outcomes. But the lack of appropriate public health funding at federal, state, and local...

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