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

Reimbursement News

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

February 15, 2018 - Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the National Bureau of Economic Research uncovered. Researchers reported that hospitals penalized under the Hospital Readmission Reduction Program (HRRP) and the...


Medicare Wellness Visit Adoption Boosts Primary Care Revenue


Practices that performed Medicare wellness visits on at least a quarter of their patients earned greater primary care revenue, experienced more patient assignment stability, and treated patients who were slightly healthier, a new Health Affairs...

CMS Opens Low Volume Appeals Settlement to Reduce Appeals Backlog


In the face of a growing Medicare appeals backlog, CMS opened the first round of a low volume appeals settlement on Feb. 5 for providers with less than 500 claim denial appeals stuck in the appeals backlog at the Office of Medicare Hearings and...

Prehabilitation Lowers Episode Costs Under Bundled Payment Models


Dedicating even a couple hours to helping patients understand and prepare for a procedure prior to surgery can save providers millions under bundled payment models, explained healthcare industry expert and former CMS official Charlene Frizzera....

85% of Hospitals to See Part B Increase Despite 340B Payment Cuts


EDITOR'S NOTE: This article has been updated with a statement from the American Hospital Association. Approximately 85 percent of hospitals will receive a net increase in their total Medicare Part B reimbursements despite recent Outpatient...

72% of Clinicians See No Adjustment Under Value Modifier in 2018


An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million eligible...

AHA, AMA and Others Offer 5 Prior Authorization Reform Strategies


Six industry groups representing providers, payers, and pharmacists recently partnered to identify strategies to improve prior authorization processes, such as decreasing the number of providers subject to prior authorizations and automating...

Exploring the Bundled Payments for Care Improvement Advanced Model


CMS recently unveiled the Bundled Payments for Care Improvement (BPCI) Advanced initiative, a new bundled payments model that will include inpatient and outpatient clinical episodes and qualify as an Advanced Alternative Payment Model (APM) under...

AHA: Global Budget Payments Help to Treat Vulnerable Communities


Global budget payments support providers treating patient populations in vulnerable communities by granting them the flexibility to address the health needs of their community, the American Hospital Association (AHA) recently stated. Millions...

Reimbursement Shortfalls, Uncompensated Care Costs Grew in 2016


Medicaid and Medicare reimbursement in 2016 was $68.8 billion short of actual hospital costs for treating beneficiaries, according to data from the American Hospital Association (AHA). The information from the AHA’s Annual Survey of Hospitals...

Judge Denies Hospital Org Attempt to Block 340B Drug Payment Cut


A federal judge recently ruled that CMS can start to reduce 340B drug payments to hospitals by $1.6 billion starting on Jan. 1, 2018, striking a blow to several industry groups that urged the court to delay enforcement of the new rule. US District...

CMS Releases Quality Payment Program Data Submission System


Eligible clinicians participating in MACRA’s Quality Payment Program can now start submitting their 2017 performance data on a new system on the program’s website, CMS recently announced in a press release. Medicare clinicians must...

New Reporting, Shared Losses Rules for MSSP ACOs in Disaster Areas


In a new interim final rule, CMS modified quality reporting and shared losses policies for Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) affected by recent natural disasters, such as this year’s major hurricanes...

AHA Opposes Medicare Reimbursement Cut for Early Hospice Care


Congress should not pass a proposed policy to reduce Medicare reimbursement rates to hospitals discharging patients to hospice care earlier than the expected, the American Hospital Association (AHA) advised. The proposed policy builds on a 2013...

Orgs Argue MIPS Adjustments for Drug Payments Harm Patient Access


Applying Merit-Based Incentive Payment System (MIPS) adjustments to Medicare Part B drug payments will restrict patient access to critical treatments, 11 medical societies recently told congressional leaders. The medical societies, including...

How CMS Improves Primary Care Payments Through Codes, APMs


New medical billing codes for non-face-to-face encounters and alternative payment models are trying to change the way Medicare reimburses for primary care, according to researchers at the Urban Institute’s Health Policy Center. The report,...

CAQH CORE Opens Certification for Electronic Prior Authorization


CAQH’s Committee on Operating Rules for Information Exchange (CAQH CORE) recently opened the certification process for Phase IV operating rules, which include standard rules for the electronic exchange of administrative data, such as prior...

Private Payer A/R, Denials Performance Troubles Hospital Revenue


Small differences in private payer performance on claims reimbursement and denials can challenge hospital revenue cycles, a new Crowe Horwath analysis of five major commercial managed care payers uncovered. “Many providers focus their attention...

Medical Billing Codes Do Not Address Full Scope of Primary Care


Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians in about 60.3 percent of visits, a recent Journal of the American Board of Family Medicine study showed....

Medicare Spends $3.1B More on Hospital-Employed Physicians


Total Medicare spending on four cardiology, orthopedic, and gastroenterology services increased by $3.1 billion between 2012 and 2015 because of the growing number of hospital-employed physicians, a recent Physicians Advocacy Institute study uncovered....

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