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

Reimbursement News

MGMA to CMS: Notify Clinicians About MIPS Eligibility ASAP

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The Medical Group Management Association (MGMA) recently called on CMS Administrator Seema Verma to immediately release Merit-Based Incentive Payment System (MIPS) eligibility notifications as well as approved vendor lists and hospital or patient-facing...

Using Bundled Payments to Pay Providers for mHealth Nudges

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Many providers have been able to extend their reach outside of their office by using mHealth technologies that encourage patients to improve their own health outcomes through nudges. However, payment structures for the healthcare encounters have...

Top 4 Claims Denial Management Challenges Impacting Revenue

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For most healthcare organizations, claim denials are a normal, if not a frequent, occurrence. While very few can boast that their denial rates are close to zero, many providers face a number of challenges with implementing an effective claims...

NH Judge Rejects CMS FAQs Clarifying Medicaid DSH Payments

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A district court in New Hampshire recently prohibited CMS from enforcing two Frequently Asked Questions (FAQs) that clarified how private payer and Medicare reimbursements paid to hospitals for dually-eligible Medicaid patients would be used...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

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The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS stated...

65% of Organized Providers Paid Via Alternative Payment Models

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Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed through...

Transradial, Same Day Discharge Cardiac Care Drops Costs by $3.7K

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From acute myocardial infarctions to coronary artery bypass grafts initiatives, recent Medicare bundled payment models have providers focusing more on reducing healthcare costs and improving care quality for a range of cardiac care episodes....

Understanding 2017 MIPS Quality, Cost Performance Categories

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CMS leaders at HIMSS17 were not shy with telling session attendees that they are currently in the first Quality Payment Program performance year. To help providers better understand the program, which launched on Jan. 1, the federal agency’s...

Payer, Provider Dialogue Key to Prior Authorization Reform

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ORLANDO - Prior authorization reform has recently been a hot topic for many healthcare industry groups and it was no different at HIMSS17. To find out more about what providers and payers plan on doing to alleviate the administrative and care...

AMGA: Slow Encounter Data Transition in Medicare Reimbursement

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The American Medical Group Association (AMGA) recently commended CMS for decelerating the transition to using encounter data as a means for risk-adjusting Medicare reimbursement to Medicare Advantage organizations in 2018. In an announcement...

GAO Finds $36B in Improper Medicaid Reimbursements in 2016

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Approximately $36 billion in Medicaid reimbursements made to providers and suppliers in 2016 were improper, a 9.8 percent increase from last year’s Medicaid improper payment amount, the Government Accountability Office (GAO) recently reported...

Should the Hospital Readmissions Reduction Program Add Sepsis?

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The Medicare Hospital Readmission Reduction Program currently determines value-based penalties on 30-day unplanned readmissions rates for six conditions. But the value-based reimbursement program may be missing a key condition that contributes...

HHS, DoJ Recovered $3.3B From Healthcare Fraud Cases in 2016

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Through healthcare fraud cases and settlements in 2016, Department of Health and Human Services (HHS) and Department of Justice (DoJ) initiatives returned over $3.3 billion to the federal government and individuals, including $1.7 billion to...

More Primary Care Leads to Less End-of-Life Medicare Spending

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Regions with more primary care providers saw less Medicare spending on end-of-life care compared to areas with less primary care practices, a recent Annals of Family Medicine study found. Medicare spending during the last two years of life was...

HHS Finalizes Solutions to Decrease Medicare Appeals Backlog

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In effort to reduce the significant Medicare appeals backlog, the Department of Health and Human Services (HHS) recently finalized several appeals process changes. Major modifications included using precedential decision-making at the Departmental...

AAFP: Primary Care Undervalued in Medicare Reimbursement

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CMS released updated physician fee schedule rates in November 2016, but the American Academy of Family Physicians (AAFP) recently contended that Medicare reimbursement rates for primary care providers are still lacking. In a letter to CMS, the...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

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The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a comment...

Drug Costs, Limited Claims Reimbursement Challenge Cancer Care

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Cancer care centers named high prescription drug costs and lack of claims reimbursement for supportive services as the top challenges associated with providing care in 2016, according to an annual Association of Cancer Care Centers (ACCC) survey....

How the 21st Century Cures Act Impacts Medicare Reimbursement

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The 21st Century Cures Act may have been a landmark law for precision medicine, drug innovation, telemedicine, and mental health reform, but the law also contained several Medicare reimbursement policy changes set to take effect starting this...

CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

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With the site-neutral Medicare reimbursement policy taking effect on Jan. 1, CMS recently released guidance on what hospital departments qualify for exemption from the rule. The federal agency clarified expanded site-neutral payment exemption...

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