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

Reimbursement News

Court Orders HHS to Eliminate Medicare Appeals Backlog by 2022


HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order. Judge James E. Boasberg of the US District Court for the District of...

5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment


Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results...

CMS Commits to Modernizing Medicare Billing for Office Visits


Finalizing the consolidation of Medicare billing codes for evaluation and management (E/M) outpatient and office visits is the first step for CMS as the federal agency modernizes the payment structure for office visits, CMS Administrator...

AHA, AAMC to Challenge Site-Neutral Payment Policy in Court


The American Hospital Association (AHA), along with the Association of American Medical Colleges (AAMC) and their member hospitals, plan to bring a lawsuit against CMS for recently released site-neutral payment rules for hospital clinic...

CMS Shifting Home Health to Value-Based Payments Under New Model


CMS recently finalized a new value-based payment system for home health agencies that would move Medicare reimbursement away from the volume of therapy delivered. Medicare will start to reimburse home health agencies under the...

Healthcare Prices Significantly Vary Across the US, HCCI Finds


Healthcare prices not only significantly varied across metro areas, but also within metro areas, a new analysis from the Health Care Cost Institute (HCCI) showed. In its first report part of the Healthy Marketplace Index (HMI) project,...

CMS to Help Medicaid Reimburse for Maternal Opioid Misuse Care


CMS recently announced that it will be awarding up to $64.6 million to 12 state Medicaid agencies to help develop Medicaid reimbursement and care delivery strategies for maternal opioid misuse treatment. The awards are part of the new...

More Site-Neutral Payments to Impact Value-Based Care, Reps Says


Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019. The Oct. 18, 2018 letter to CMS...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule


About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows. The 200...

Auditors Recouped $214M in Medicare Improper Payments in 2016


Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned...

Medicare Advantage Plans Overturn 75% of Their Own Claim Denials


A new report from the HHS Office of the Inspector General (OIG) reveals “widespread and persistent problems” related to prior authorization and claim denials in Medicare Advantage. Using Medicare Advantage data on denials,...

Clinical Documentation Improvement Solutions Up Provider Revenue


Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of healthcare executives, medical records...

AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments


CMS should withdraw new proposals to expand site-neutral payments to hospital outpatient clinic visits and services from expanded clinical families delivered at off-campus provider-based departments (PBDs), the American Hospital...

Providers Oppose Collapsing Medicare Reimbursement for E/M Visits


Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5 visits. In a recently proposed rule for...

RCCH Uses Predictive Analytics to Boost Claim Denials Management


Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue Cycle at Tennessee’s RCCH...

AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment


The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services. The 2019 CPT code set...

Paying LTCHs Like Skilled Nursing Would Save $4.6B, Analysis Finds


Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper found. Medicare savings would stem from the...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs


Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a...

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