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

Reimbursement News

Payment Reform Suggestions to Improve Complex Pediatric Care

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Payment reform for medically complex children is needed to support a more family- and patient-centered care delivery model that requires extensive care coordination and non-face-to-face services, a new study in Pediatrics...

Tips for Negotiating Claims Reimbursement Rates with Payers

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Every dollar counts in the healthcare revenue cycle, especially with declining Medicare reimbursement rates and new value-based care models. But organizations should understand how to successfully negotiate claims reimbursement contracts...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

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In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims accounted for $10.45 billion in improper...

CMS Updates Site-Neutral Payment Reform Implementation Rule

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In a recent ruling on the outpatient prospective payment system, CMS finalized several changes to the site-neutral payment reform policy under which most provider-based hospital outpatient departments will no longer receive outpatient...

CMS Offers 66% Settlement to Reduce Medicare Appeals Backlog

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In an effort to resolve the Medicare appeals backlog, CMS recently reopened a settlement option that would allow hospitals to receive partial reimbursement for some claim denials currently stuck in the appeals process. Similar to the 2014...

CMS Issues Final Rule on Home Health Medicare Reimbursement

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CMS recently released a final rule that will reduce Medicare reimbursement to home health providers by $130 million, or 0.7 percent, in 2017. Lower Medicare spending on home health services will stem from updates to payment rates, the Home...

Senate Group Drafts Chronic Disease Management Payment Reform

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The Senate Finance Committee Chronic Care Working Group recently released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, telehealth consultations,...

CMS Updates ESRD, Dialysis Medicare Reimbursement Policies

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End-stage renal disease (ESRD) and dialysis providers can expect a 0.73 percent increase in total payments compared to last year under new Medicare reimbursement rates, CMS recently announced. Medicare spending on ESRD payments is...

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...

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