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

Reimbursement News


Healthcare Spending Growth Slows, Increasing 3.9% in 2017


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


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


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


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


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


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...

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds


Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more than one full-time equivalent...

Court Orders HHS to Eliminate Medicare Appeals Backlog by 2022


HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order. Judge James E. Boasberg of the US District Court for the District of...

5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment


Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results...

CMS Commits to Modernizing Medicare Billing for Office Visits


Finalizing the consolidation of Medicare billing codes for evaluation and management (E/M) outpatient and office visits is the first step for CMS as the federal agency modernizes the payment structure for office visits, CMS Administrator...

AHA, AAMC to Challenge Site-Neutral Payment Policy in Court


The American Hospital Association (AHA), along with the Association of American Medical Colleges (AAMC) and their member hospitals, plan to bring a lawsuit against CMS for recently released site-neutral payment rules for hospital clinic...

CMS Shifting Home Health to Value-Based Payments Under New Model


CMS recently finalized a new value-based payment system for home health agencies that would move Medicare reimbursement away from the volume of therapy delivered. Medicare will start to reimburse home health agencies under the...

Healthcare Prices Significantly Vary Across the US, HCCI Finds


Healthcare prices not only significantly varied across metro areas, but also within metro areas, a new analysis from the Health Care Cost Institute (HCCI) showed. In its first report part of the Healthy Marketplace Index (HMI) project,...

CMS to Help Medicaid Reimburse for Maternal Opioid Misuse Care


CMS recently announced that it will be awarding up to $64.6 million to 12 state Medicaid agencies to help develop Medicaid reimbursement and care delivery strategies for maternal opioid misuse treatment. The awards are part of the new...

More Site-Neutral Payments to Impact Value-Based Care, Reps Says


Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019. The Oct. 18, 2018 letter to CMS...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule


About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows. The 200...

Auditors Recouped $214M in Medicare Improper Payments in 2016


Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned...

Medicare Advantage Plans Overturn 75% of Their Own Claim Denials


A new report from the HHS Office of the Inspector General (OIG) reveals “widespread and persistent problems” related to prior authorization and claim denials in Medicare Advantage. Using Medicare Advantage data on denials,...

Become a member

Complete your profile below to access this resource.

Thanks for subscribing to our newsletter. Please fill out the form below to become a member and gain access to our resources.

Reset your password

Enter your email address to receive a link to reset your password


Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...