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

Latest RCM News News

Baylor Scott & White, Memorial Hermann Eye Hospital Merger Deal

October 2, 2018 - Two major non-profit health systems in Texas recently announced their plans for a hospital merger, which is expected to advance cost-effective patient care in the state. Baylor Scott & White Health, a non-profit based in Dallas, Texas, and Memorial Hermann Health System, another non-profit in Houston, stated on Monday, Oct. 1, 2018, that their boards signed a letter of intent to...


CMS Clarifies Healthcare Price Transparency Rules for Hospitals


CMS recently expanded on new healthcare price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the...

CMS Finds Errors in 2019 MIPS Payment Adjustment Calculations


CMS recently announced that it is extending the targeted review deadline for 2017 Merit-Based Incentive Payment System (MIPS) performance feedback after the federal agency identified three errors with the scoring logic for the 2019 payment...

Hospitals Create Drug Company to Combat Drug Shortages, Prices


Seven health systems are stepping up to the plate to tackle two of the healthcare industry’s most pressing challenges: drug shortages and rising prescription drug rates. Catholic Health Initiatives, HCA Healthcare, Intermountain...

Next Generation ACOs Save Medicare $62M, Maintain Care Quality


Accountable care organizations (ACOs) in the Next Generation ACO program produced nearly $62 million in net savings to Medicare while maintaining care quality in 2016, CMS recently reported in the newly released evaluation of the...

CMS Initiative to Create Pediatric APMs to Address Opioid Crisis


A new CMS Innovation Center initiative will call on local stakeholders and Medicaid agencies to develop alternative payment models that address the impact of the opioid crisis for children, CMS recently announced. Medicaid and local...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value


CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make the move by implementing the...

CMS Proposes to Extend Site-Neutral Payments to Clinic Visits


CMS recently proposed to implement site-neutral payments for clinic visits provided at off-campus provider-based hospital departments. According to a recently proposed CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS)...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH


CMS recently approved a five-year Section 1115 demonstration allowing New Hampshire to provide Medicaid reimbursement to more behavioral health facilities for substance use disorder treatment services. The approval authorizes the Granite...

CMS Aims to Protect Medicaid Payments to Providers, Not 3rd Parties


CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed regulatory change to the Medicaid...

CMS Postpones Deadlines for New Bundled Payments Model


Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced...

CMS Proposes New Grouping Model for Medicare Home Health Payments


CMS recently proposed a rule that would implement the Patient-Driven Groupings Model for Medicare home health payments by 2020. The rule would eliminate the current Medicare reimbursement system for home health agencies, which pays home...

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans


CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare...

Healthcare Claims Management Market to Reach $13.9B by 2023


The global healthcare claims management market is slated to reach $13.93 billion by 2023, up from a valuation of $10.16 billion in 2017, MarketsandMarkets recently reported. The significant projected growth in the healthcare claims...

Over 600 Individuals Charged in 2018 Healthcare Fraud Takedown


The HHS Office of the Inspector General (OIG) and Department of Justice (DoJ) recently announced the largest healthcare fraud takedown to date, with over 600 defendants charged with participating in fraud schemes amounting to about $2...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs


CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is...

CMS Accounts for Extreme Situations in CJR Bundled Payments


CMS updated rules for the Comprehensive Care for Joint Replacement (CJR) bundled payments model to protect participating hospitals from uncontrollable episodes costs incurred during an emergency period, like the recent Hurricanes or...

Fixing Medicare, Medicaid a Top Priority for New Coalition


Healthcare industry heavy-hitters are partnering to form a new coalition that generally aims to “improve what’s working in health care and fix what’s not,” especially in Medicare, Medicaid, and other government...

HHS Mulls Private Sector Dialogue to Foster Healthcare Innovation


HHS is floating the idea of creating a workgroup of private healthcare companies to advise the federal department on healthcare innovation and investment, according to a new Request for Information (RFI) notice. The federal department is...

91% of Eligible Clinicians Participated in 2017 MIPS Reporting


Approximately 91 percent of all eligible clinicians participated in 2017 Merit-Based Incentive Payment System (MIPS) reporting, exceeding the CMS goal of 90 percent participation in the first year of the Quality Payment Program, the...

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