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

Reimbursement News

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...

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...

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...

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...

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...

CMS Boosts Payments to Hospitals Impacted by Two-Midnight Rule


Sixty-seven hospitals affected by the Two-Midnight Rule will receive a boost in Medicare reimbursement on Part A discharges for the next year, a recent CMS notice explained. The notice ordered Medicare Administrative Contractors (MACs) to...

KLAS: Quadax, SSI Group Earn Top Scores for Claims Management


Respondents in a recent KLAS report named Quadax, SSI Group, and ZirMed as the best overall performing claims management vendors because of the high-quality customer service and support provided by the companies. The 296 healthcare...

Hospital Orgs to Sue CMS Over 340B Medicare Reimbursement Cuts


The American Hospital Association (AHA), America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) recently announced their intentions to pursue litigation against CMS to prevent Medicare reimbursement...

29% of Healthcare Payments Under Alternative Payment Models


About 29 percent of healthcare payments in 2016 were paid through an alternative payment model, such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, the Health Care Payment Learning and Action...

4 Strategies for Merit-Based Incentive Payment System Success


Medicare providers who qualify to participate in MACRA’s Merit-Based Incentive Payment System (MIPS) face up to a 4 percent incentive payment or penalty based on their performance in 2017. Despite MIPS putting revenue at risk, many...

382 Hospitals Earn Initial Reconciliation Payments Under CJR Model


Out of approximately 800 hospitals required to participate in Medicare’s Comprehensive Joint Replacement (CJR) model, 382 facilities will receive a reconciliation payment based on cost savings and care quality, according to...

AHA: OIG Hospital Audit Extrapolation Led to Excessive Claim Denials


The American Hospital Association (AHA) recently urged CMS to reconsider its extrapolation approach when conducting Office of the Inspector General (OIG) hospital audits because the method leads to excessive repayment requests and claim...

Specialists Face 16% MIPS Payment Adjustment Swing Under Proposal


Specialists could face up to a 16 percent value-based incentive payment or penalty under MACRA’s Merit-Based Incentive Payment System (MIPS) in 2018 if a proposed rule to include Medicare reimbursement for Part B drugs in the program...

Cancer Care Costs 60% Higher at Hospitals Vs Independent Orgs


Hospital-based cancer care for patients undergoing chemotherapy was 60 percent more expensive compared to the same treatment at community-based oncology practices, according to a recent study by Xcenda and Lucio Gordan, MD, Medical...

Reps Eye Delay for Medicaid Disproportionate Share Hospital Cuts


Three House Representatives recently called on their Congressional peers to postpone implementing a rule that would reduce Medicaid Disproportionate Share Hospital (DSH) payments starting on Oct. 1, 2017. The bipartisan letter from...

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues


Electronic claims management adoption continues to face challenges related to healthcare Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA), a new Workgroup for Electronic Data Interchange (WEDI) white paper...

AHA Questions Accuracy of Combined Post-Acute Care Payment System


CMS and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) should address fundamental issues with the prototype of a combined Medicare post-acute care payment system, a recent Dobson DaVanzo & Associates report...

HHS Offers Special Medicare Reimbursement After Hurricane Irma


In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment...

Driven by Fee-For-Service, Docs Say Up to 30% of Care Unnecessary


At least 15 percent to 30 percent of medical care is unnecessary, contributing to low-value resource use and wasteful healthcare spending, stated the majority of physicians surveyed in a recent PLOS ONE study. While the survey of...

17% of Practices Pay Fees for Electronic Healthcare Payments


Approximately 17 percent of physician practices are forced to pay a fee for receiving electronic healthcare payments from their payers, with fees ranging between 2 and 5 percent of the total reimbursement, a recent MGMA poll of over 900...

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