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

Reimbursement News

Federal Policies to Decrease Hospital Payments by $218B by 2028

June 19, 2018 - Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed. The report commissioned by the Federation of American Hospitals (FAH) and the American Hospital Association (AHA) determined the cumulative federal hospital payment reduction stemming from policies...


Electronic Claims Management Adoption Could Save Providers $9.5B


Transitioning from manual to fully electronic claims management would save the healthcare industry $11.1 billion annually, with providers seeing the greatest share of the savings, the fifth annual CAQH Index found. Providers would save approximately...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge


Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced alternative...

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 programs,...

Oncologist Org Fights Medicare Reimbursement Cut to Cancer Drugs


A group representing over 5,000 independent, community-based oncologists is suing HHS over the implementation of a two percent sequester cut to Medicare reimbursement for Part B cancer drugs. The Community Oncology Alliance (COA) is arguing that...

ER Spending Rose 99% Since 2009 Despite No Change in Utilization


Emergency room (ER) spending per person grew 99 percent between 2009 and 2016 despite ER utilization remaining the same during the period, new data from the Health Care Cost Institute (HCCI) revealed. “Emergency room visits are not planned....

Expanded Resolution Process Opens to Lower Medicare Appeals Backlog


HHS recently announced an expanded alternative dispute resolution process that aims to reduce the growing Medicare appeals backlog. The expanded Settlement Conference Facilitation (SCF) process promises to streamline Medicare dispute resolutions...

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt


CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is lacking. According...

Primary Care Physician Shortage Driving Bump in Compensation


Primary care physician compensation increased by more than 10 percent over the past five years. But the rise in pay indicates a worsening primary care physician shortage, according to the 2018 DataDive Provider Compensation report from the Medical...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion


CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative payment...

Most Physicians Will Not Drop Payer Contract Despite Poor Pay


Provider organizations should be monitoring their payer contracts to ensure fair reimbursement, but most physicians still would not drop a payer if they were paying poorly, a recent Medscape survey found. The poll of 20,000 physicians across...

Hospitals Wait 16 More Days for Late Payments from Claim Denials


Delayed payments stemming from claim denials are significantly impacting hospital revenue cycles, taking an average 16.4 more days to pay compared to claims that have not been denied, a new analysis from Crowe Horwath revealed. The analysis of...

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities


CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven Payment...

CMS Seeks Info on a Direct Provider Contracting Model for Medicare


CMS is seeking comments on a potential alternative payment model that would allow primary care providers to directly bill Medicare beneficiaries through a direct provider contracting model. Currently, providers must opt out of Medicare for two...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder


The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new alternative payment...

CMS Appeals Ruling on Changing Medicaid DSH Payment Rules in MO


CMS is appealing a recent federal court decision that barred the agency from enforcing a 2017 final rule and two sub-regulatory articles from 2010 in Missouri. The federal agency stated that rule and articles clarified the formula for calculating...

Bundled Payments with Drug Costs Threaten Cancer Care Quality


Oncology bundled payments that include drug costs would negatively impact cancer care, a new report in the Journal of Oncology Practice showed. According to the report done by Milliman, Inc. for the American Society of Clinical Oncology (ASCO),...

HHS, DoJ Recovered $2.6B from Healthcare Fraud Schemes in 2017


For every dollar the federal government spent on combatting healthcare fraud and abuse in the last three years, the government recovered $4, HHS recently reported. While federal healthcare fraud investigations returned a significant amount of...

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs


The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the commission’s...

Medical Billing Complexity Highest for Medicaid Fee-for-Service


Medical billing for Medicaid fee-for-service claims proved to be the most complex across all insurers. The public payer had a claims denial rate 17.8 percentage points greater than the rate for Medicare fee-for-service claims, a new Health Affairs...

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