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

Reimbursement News

Hospitals Seek Another Delay for $4B Medicaid DSH Payment Cut

February 22, 2019 - America’s Essential Hospitals, American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and five other national hospital groups are calling on policymakers to implement another delay for scheduled cuts to Medicaid Disproportionate Share Hospital (DSH) allotments. The Affordable Care Act (ACA) requires policymakers to reduce Medicaid DSH payments. At...


Articles

Healthcare Spending Slated to Increase 5.5% Annually Until 2027

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National healthcare spending increased by approximately 4.4 percent in 2018, and the rate of growth is slated to significantly rise over the next decade, according to a new report from the Office of the Actuary at CMS. The report,...

Bots Make Claim Status Inquiry More Efficient for Avera Health

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Robots in healthcare do not have to be large human-like machines that replace providers. But bots embedded in software applications can be a key tool for reducing the burden of mundane, common tasks, such as claim status inquiry. At least...

Medicare, Medicaid Spending Per Enrollee Slower Than Private Plans

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Medicare and Medicaid spending saw significantly slower growth per enrollee than private payer expenditures over the last decade, a new report from the Urban Institute shows. The public payers may have experienced the fastest rate of...

HHS Releases Alternative Payment Model for Ambulance Providers

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HHS and the CMS Innovation Center (CMMI) recently announced a new alternative payment model for ambulance providers that aims to improve Medicare emergency transport services. The five-year Emergency Triage, Treat, and Transport (ET3)...

More Hospitals Sue HHS Over Outpatient Site-Neutral Payments

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Thirty-eight hospitals filed a lawsuit against HHS over a $380 million reduction in Medicare reimbursement to hospitals under a new outpatient site-neutral payment policy. The lawsuit alleges that HHS Secretary Alex Azar overstepped his...

Claims Management Automation Progresses, But Opportunities Remain

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Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index. The CAQH 2018 Index showed adoption of fully electronic eligibility and...

Medicare, Medicaid Reimbursement $76.8B Under Hospital Costs

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The largest public payers continue to underpay hospitals, data from the most recent American Hospital Association (AHA) Annual Survey of Hospitals revealed. Medicare and Medicaid reimbursement fell $76.8 billion short of the actual costs...

Specialists Fear IPI Drug Pricing Model Could Harm Patient Access

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A healthcare industry group representing more than 7,700 rheumatologists and rheumatology health professionals recently warned the Trump Administration that its proposed International Pricing Index (IPI) drug pricing model for Medicare...

HHS Overstepped Authority with 340B Reimbursement Cuts, Judge Rules

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A federal judge in Washington DC recently struck down a nearly 30 percent reduction in 340B reimbursement cuts. US District Judge Rudolph Contreras ruled that HHS Secretary Alex Azar exceeded his statutory authority by issuing a policy...

Average Healthcare Costs for Outpatient Visit Nears $500

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Healthcare spending growth may be slowing, but healthcare costs in the US still significantly outpace those of other nations, a new analysis shows. As part of a larger study to determine the funding and services needed to achieve...

Healthcare Spending Growth Slows, Increasing 3.9% in 2017

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Healthcare spending grew at a rate of 3.9 percent in 2017, slowing to rates observed during the 2008 to 2013 period, CMS actuaries recently reported. The analysis from the Office of the Actuary at CMS, published by Health Affairs, showed...

New Medicare Reimbursement for Lab Tests May Overpay by Billions

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A new Medicare reimbursement system for clinical laboratory tests could increase spending for the public healthcare program by over $11 billion by 2020, a new Government Accountability Office (GAO) report shows. The federal watchdog found...

AHA, AAMC Sue HHS Over Site-Neutral Payment Expansion

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The American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and three healthcare organizations are suing HHS over a new site-neutral payment policy slated to take effect on January 1, 2019. The site-neutral...

Hospital Wage Data Inaccuracies Led to Medicare Reimbursement Issues

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CMS may not be appropriately adjusting Medicare reimbursement to hospitals for local labor prices, a new HHS Office of the Inspector (OIG) report reveals. The HHS watchdog found “significant vulnerabilities” in the hospital...

Medicare Reimbursement Rules Limit Telehealth Adoption

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Telehealth utilization among Medicare beneficiaries is on the rise, but restrictive Medicare reimbursement rules are stifling the adoption of such services, a new report shows. The CMS report on Medicare telehealth utilization between...

Medicare Improper Payment Rate Down to 8.12%, Lowest Since 2010

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CMS recently reduced the Medicare improper payment rate as well as the improper payment rates for Medicaid and the Children’s Health Insurance Program (CHIP) for the first time in reporting history, the head of the federal agency...

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