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

Reimbursement News

25% of Healthcare Payments Tied to Alternative Payment Models

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Only one-quarter of healthcare payments in 2016 will be connected to an alternative payment model that has population-based accountability, reported the Healthcare Payment Learning & Action Network (LAN). The survey of over 70...

Patients Find Medicare Reimbursement to Surgeons Too Low

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Patients may be willing to pay more out-of-pocket expenses for certain medicals services, such as knee surgeries, especially as providers face lower Medicare reimbursement rates, a recent study in Orthopedics contended. The survey of 231...

AHA Offers HHS Solutions to Reduce Medicare Appeals Backlog

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The American Hospital Association (AHA) recently advised the Department of Health and Human Services (HHS) to implement three solutions that would significantly reduce the Medicare appeals backlog at the administrative law judge...

Medicare Reimbursement Covers 88% of Medical Equipment Costs

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Medicare reimbursement rates under the Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program only cover 88 percent of overall healthcare costs associated with providing home medical equipment,...

Hospitals Still Facing Medicare Claims Denial Management Issues

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A recent American Hospital Association (AHA) survey indicated that hospitals are still experiencing challenges with Medicare claims denial management under the Recovery Audit Program. The survey of 676 hospitals revealed that about 60...

Impact of Quality Payment Program on Medicare Reimbursement

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With the final rule on MACRA implementation finally emerging, eligible clinicians were presented with a range of Quality Payment Program participation options that would impact Medicare reimbursement payment adjustments in 2019. The...

Higher Medicare Reimbursement Not Related to Better Quality

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According to a recent study in JAMA Surgery, Medicare reimbursement amounts for patients who were rescued from surgical complications were two to three times greater at the highest cost-of-rescue hospitals, even though patient outcomes...

OIG: Add Medical Device Data to Claims Reimbursement Forms

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Claims reimbursement forms lacking appropriate fields for medical device information make it more difficult for CMS to reduce Medicare spending associated with recalled or failed devices, the Department of Health and Human Services (HHS)...

Bundled Payments Model Cuts Joint Replacement Costs by $1,166

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Hospitals participating in the Bundled Payments for Care Improvement initiative decreased Medicare spending on lower extremity joint replacement hospitalizations by $1,166 per episode compared to non-participating hospitals, reported a...

Group Calls for Dual-Eligible Claims Reimbursement Changes

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In a recent report, the Bipartisan Policy Center’s Health Project has urged federal officials to improve care delivery for dually eligible Medicaid and Medicare beneficiaries by revising claims reimbursement models to better align...

Court Denies HHS Wish to Delay Medicare Appeals Backlog Case

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A federal district court recently denied a request from the Department of Health and Human Services (HHS) to postpone proceedings on a Medicare appeals backlog case until Sept. 30, 2017, according to the court’s decision. US...

AHA Urges CMS to Withdraw Uncompensated Care Payment Changes

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The American Hospital Association (AHA) recently penned a letter to CMS Acting Administrator Andy Slavitt urging the federal agency to withdraw its proposed rule to include third-party payments, such as private payer and Medicare...

CMS Releases DMEPOS Medicare Reimbursement Rates, Contracts

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CMS has announced new Medicare reimbursement rates for some medical equipment items and started to send contract offers to winning bidders for Medicare’s Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies...

AMGA: Tie Medicare Reimbursement to Care Coordination Metrics

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According to two comment letters to CMS, the American Medical Group Association (AMGA) has urged the federal agency to better align Medicare reimbursements and value-based incentive payments to promote enhanced care coordination. The...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

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Medicare spending would decrease by approximately $19 million a year once CMS fully implements new claims reimbursement rates for accessories associated with some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS),...

MedPac Suggests More Claims Reimbursement Cuts for Home Health

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The Medicare Payment Advisory Commission (MedPac) is advising CMS to deepen proposed Medicare reimbursement cuts to home health advisors to better align with actual costs and compensate for systematic overpayments. The call for more...

Can Changes to Medicare Reimbursement Appeals Reduce Backlog?

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The lengthy Medicare reimbursement appeals process poses significant revenue cycle management problems for many providers, yet new proposed fixes from HHS may not do much to solve the problem, argue several industry groups. In June, HHS...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

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The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to...

AHA: Delay Site-Neutral Rule to Address Medicare Fraud Risks

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The American Hospital Association (AHA) has asked CMS to delay the implementation of proposed site-neutral payments for another year because the payment reform rule could increase a hospital’s Medicare fraud and abuse...

AHA Critiques Medicare Reimbursement Changes for Home Health

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The American Hospital Association (AHA) is urging CMS to delay outlier provisions and streamline certain medical billing procedures proposed in a recent document aimed at home health facilities. In June, CMS released a proposed rule that...

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