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

Policy & Regulation News

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...

In IRS First, Non-Profit Hospital Loses Status Under ACA Rules

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The IRS recently revoked a rural hospital’s non-profit status for failure to meet new community health needs assessment requirements under the Affordable Care Act. According to an IRS letter dated Feb. 14, 2017, the unnamed hospital...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

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CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. The federal agency originally introduced the...

AMGA: MIPS Exclusion Rules Inhibit Value-Based Care Under MACRA

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The American Medical Group Association (AMGA) recently opposed several proposed changes to the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. The group particularly expressed...

New Medicare Fraud Audits to Ease Burden on Compliant Providers

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CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted...

Court to Reconsider Timeline for Medicare Appeals Backlog End

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The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models

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UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

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Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This...

CMS Details $43B Drop in Medicaid Uncompensated Care Support

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In a recently proposed rule, CMS outlined a methodology for reducing Medicaid support for hospitals incurring significant uncompensated care costs starting in 2018. The rule would implement reductions of $1 billion per year in Medicaid...

CMS Considers Behavioral Health Alternative Payment Model

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CMS recently announced its intention to develop an alternative payment model targeting behavioral health services. The federal agency is seeking stakeholder feedback on model development in a public meeting on Sept. 8, 2017, in...

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